At the 2023 Skin of Color Update conference in New York City, renowned expert Dr. Gilly Munavalli delved into the application of lasers and energy-based devices for treating acne scars, particularly focusing on patients with skin of color. Here, you can find a simplified overview of the key insights shared during the meeting for those who may have missed it.
Dr. Munavalli shared that his practice often caters to individuals with African American and South East Asian skin. These patients are frequently referred from practices less experienced in treating diverse skin tones, as addressing these specific needs poses unique challenges. Dr. Munavalli’s presentation zeroed in on acne scarring, emphasizing its connection to hyperpigmentation, laxity, and aging skin.
Rising Demand and Limited Education
The demand for cosmetic treatments has surged, with a notable increase in both surgical and non-surgical procedures between 2010 and 2016. However, despite a growing population seeking dermatologic care and cosmetic procedures, education and literature about skin color and dermatology remain limited.
Common Concerns in Skin of Color
Skin of color often presents unique concerns, including pigmented lesions, epidermal growths, and acne scarring, which can be exacerbated by photoaging and sagging. Dr. Munavalli highlighted the use of non-ablative fractional lasers to address these concerns effectively through its mechanism of action which heats the dermis, leads to collagen remodelling, and subsequently improves the depth of scars.
Hyperpigmentation Treatment – Laser Toning
Dr. Munavalli began his discussion with laser toning using a 1064 nanometer laser for hyperpigmentation, a treatment accessible to anyone. This method, conducted over multiple sessions, can yield remarkable improvements.
Persistent Post-Acne Pigmentation
Dr. Munavalli addressed the persistence of post-acne pigmentation, emphasizing its significant impact, especially on darker skin types. This post-inflammatory hyperpigmentation frequently causes more distress than the acne itself, a point emphasized by several presenters during this meeting. Treatment options for persistent post-acne pigmentation include retinoids, bleaching agents like hydroquinone, chemical peels, and laser toning with QS or Picosecond 1064 nm ND-YAG. Many of these treatments are currently more readily accessible, offering diverse combinations and strengths through different compounding pharmacies.
General Practice Considerations
For successful resurfacing in skin of color, Dr. Munavalli recommended low fluency, low density, fewer passes, increased cooling, avoiding pulse stacking, using test spots, and adjusting the total number of treatments and intervals accordingly.
Acne Scar Types and Treatment Options
Dr. Munavalli categorized acne scars into various types and recommended tailored treatment options, including laser treatments, TCA cross, subcision, dermal fillers, fractional resurfacing, microneedling, and fully ablative resurfacing.
| SCAR TYPE | TREATMENT OPTION |
| Macular Erythema
Macular hypopigmented |
|
| Icepick |
|
| Depressed Distensible |
|
| Boxcar/Fixed |
|
Additional Treatments
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- Dermal Fillers: Effective for softening wrinkles and scars, particularly in skin of color. Annual touch-ups may be required.
- Microneedling: Minimal downtime, one pass treatment, utilizes radio frequency energy to promote neocollagenesis for improved skin health.
- Picosecond and Combination Treatments: Dr. Munavalli suggested combining TCA, fractional, and subcision, followed by picosecond treatment for a more aggressive yet effective approach.
Safety and Efficacy
Dr. Munavalli presented data from a prospective multi-center trial showing the safety and efficacy of microfocused US treatment for improving acne scar appearance. The results indicated a significant improvement in acne scars for the majority of subjects.1
In summary, Dr. Munavalli’s comprehensive exploration of laser and energy-based devices for treating acne scars, particularly in patients with skin of color, underscores the critical need for tailored approaches in dermatological care. He emphasized the benefits of combining various treatments to optimize clinical response. Dr. Munavalli’s expertise in tackling challenges with diverse skin tones, focusing on issues like hyperpigmentation and aging skin, provides valuable guidance for practitioners wanting to feel more comfortable and knowledgeable in treating pigmented skin tones.
References
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- Sofwave Medical announced FDA clearance of SUPERB technology for treatment of acne scars. August 30, 2023. https://www.biospace.com/article/releases/sofwave-medical-announces-fda-clearance-of-superb-technology-for-treatment-of-acne-scars/
This information was presented by Dr. Gilly Munavalli during the 2023 Skin of Color Update conference. The above highlights from his lecture were written and compiled by Dr. Sarah Millan.
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