Common Skin Concerns

Treatment options for many indications are limited for the skin of color community. Many of these options mainly consist of creams, topicals, serums, and oral medications with a lack of advanced therapy alternatives.
The following skin concerns are now able to be addressed by 650-microsecond lasers due to the inherent technology.*

What is it? Acne is one of the world’s most common chronic skin disorders affecting the hair follicle and sebaceous gland, where there is an expansion and blockage of the follicle causing inflammation. It can manifest at any age on the face, neck, back, and shoulders. 

For skin of color patients who develop acne, hyperpigmentation issues from inflammation tend to be the chief complaint – even after a breakout subsides. Post-inflammatory pigmentation is a major concern for patients. 

How does the laser work for acne? The laser helps to clear acne breakouts and reduce the occurrence of future breakouts in several ways. The laser energy kills the active p. acnes bacteria and reduces the inflammation of existing breakouts. By delivering energy into the sebaceous glands it helps to suppress overactive sebum production to lessen excess oil output. 

What is it? Acne keloidalis is a chronic inflammatory condition that leads to fibrotic plaques, papules, and possible alopecia commonly seen on the nape of the neck.

Studies report the incidence of acne keloidalis nuchae being between 0.45% and 9% occurring mostly in darker-skinned races with curly hair. Most affected persons show the presence of an abnormal scalp bacterium that is believed to contribute to the longevity of this problem. In the affected areas, local tissue damage from the curved, angled hair pushing through the skin can start the initial inflammation.

How does the laser work for acne keloidalis nuchae? Much like other chronic inflammatory conditions caused by hair, laser energy can be used as first-line therapy to eradicate problem areas where the hair follicle is initiating inflammation. The laser energy can also be used to reduce inflammation in affected areas, while also reducing fibrotic areas by eliminating the blood flow supply.

What is it? Atrophic acne scars are the most common form of scarring, especially on the face. The depressed scars sit below the surrounding skin and form when not enough collagen is made while the wound, formed by the acne inflammation, is healing. Atrophic acne scars appear in three different types:

Boxcar – wide, U-shaped scars with edges, which can be shallow or deep.

Ice pick – narrow, V-shaped scars that are deep and can look like round or oval holes.

Rolling – wide depressions with rounded edges and an irregular, rolling pattern.

How does the laser work for acne scars? Effective treatment of facial acne scarring presents a major challenge. The laser works by thermally stimulating dermal collagen remodeling, effectively softening the appearance of them by ‘plumping’ them up by rebuilding collagen. The 650-microsecond laser is able to deliver enough energy per pulse and with multiple passes into the dermis to effectively stimulate the rebuilding of collagen without damaging the epidermis or surrounding skin tissue.

What is it? Dermatosis papulosa negra or (DPN) appear on the skin as small brown or black spots, especially around the cheekbones and eyes. The spots may also be found on other areas of the face, neck, chest, and back.

DPN occurs most frequently in people of color, especially women.  They tend to appear with age and grow in size and number. While they are not cancerous or of medical concern, they can be irritating or cosmetically undesired.

How does the laser work for DPN? Effective treatments such as curettage and cryotherapy are aggressive and usually associated with hypopigmentation and hyperpigmentation, scarring, and keloid formation. The 650-microsecond laser energy safely and effectively coagulates the melanin in the lesion as well as the blood vessels supporting the lesion.

What is hidradenitis supperativa?  A chronic, debilitating inflammatory disease of the hair follicles with a wide spectrum of severity. It is characterized by post-pubertal onset of painful recurrent boils in the axilla, groin, and anogenital regions. African Americans are estimated to make up 65% of the HS population in the United States, have the highest 1-year incidence among all age groups, and double the incidence compared with Caucasian individuals. 

Persons of African descent have larger, more numerous, and more productive apocrine glands compared to Caucasian persons. In addition, more research on genetic mutations and polymorphisms is needed to better understand the relationship between HS and HS-related syndromes among patients with skin of color, such as polycystic ovary syndrome, inflammatory bowel diseases, follicular occlusion tetrad, pyogenic arthritis, pyoderma gangrenosum, and acne. 

  • Keloid formation prevalence is 5-15x higher than in Caucasian skin
  • Areas of dense concentration of melanin are more susceptible to keloid formation vs. parts of the body without i.e. palms
  • Black skin makes up 65% of hidradenitis suppurativa cases

How does the laser work for hidradenitis supperativa? The 650-microsecond laser can help HS in several ways, including prevention by addressing hair reduction and acne clearance, and maintenance of inflammatory lesions and keloids. The laser treatment can result in reducing inflammatory lesions without the formation of abscesses and sinus tracts as well as reducing existing or the formation of keloids.

What is hyperpigmentation? Hyperpigmentation is a broad term for the dark coloring of a person’s skin. It can present in a number of different forms by factors including genetics, trauma, and photodamage. While hyperpigmentation is a condition that affects all skin tones, it is definitely more common for people of color. Darker skin tones are more affected by hyperpigmentation because of the presence of increased melanin in the skin.

How does the laser work for hyperpigmentation? The 650-microsecond energy addresses the areas of increased pigment by coagulating the hyperpigmented areas. Depending on the type of hyperpigmentation, if there is an inflammatory component, the laser energy will coagulate the microvasculature supplying the inflammation. 

What are keloids? A keloid is a scar that forms beyond the boundary of a wound and develops to become thick, fleshy, and raised. This scarring occurs due to an overproduction of collagen. Some ethnic groups are at a greater risk of developing them. People with darker skin, such as African Americans, Asians, and Hispanics are more susceptible. Keloid scars are seen 15 times more frequently in highly-pigmented ethnic groups than in Caucasians.

How does the laser work for keloids? The 650-microsecond laser energy induces structural changes in the collagen-bearing tissue at the mid-to-deep dermal level. The laser energy helps to coagulate the blood vessels supporting the growth of the keloid. Because the laser does not create a thermal injury to surrounding tissue, the rate of recurrence of keloids is minimized.

What is keratosis palmaris et plantaris? This condition presents with thickening of the skin of the palms and/or soles which may be diffuse, involving most of the palms and soles, or focal, which is localized mainly to pressure areas. The disease can be both hereditary or caused by a number of inflammatory conditions such as psoriasis and eczema.

How does the laser work for keratosis palmaris et plantaris? The 650-microsecond laser energy can help prevent the formation of this condition by suppressing inflammation from causative factors like psoriasis, effectively coagulating the vascular issue at the source.

What is keratosis pilaris?  Keratosis pilaris is the result of inefficient natural exfoliation of dead cells. Skin cells are made from a protein called Keratin, which when not exfoliated, can build up causing clogging at the opening of hair follicles leaving skin with brownish/blackish bumps that can sometimes be raised and irritated. While this condition can affect any population, 1 in 20 patients with skin of color suffers from it, making it a very common skin condition.

How does the laser work for keratosis pilaris? The 650-microsecond laser can address this condition by removing unwanted hair that causes the irritation to form. For existing inflammation, the laser can suppress the inflammation by coagulating the microvasculature forming the raised bumps.

What are lentigines? Lentigines are benign lesions that occur on the sun-exposed areas of the body, commonly forming on the face and backs of hands. They frequently arise in sun-exposed sites in people who tan easily or who have naturally dark skin.

How does the laser work for lentigines? The 650-microsecond laser energy is applied to the lesion to coagulate the excess melanin. The excess melanin will eventually slough off and the area will naturally return to its normal skin tone.

What is melasma? Melasma is a skin condition that presents as a bilateral, blotchy, brownish facial pigmentation, commonly seen mainly in women on the upper lip, cheeks, and forehead. Melasma appears when these cells become hyperactive and produce too much pigment in certain areas of the skin. The mechanism is similar to what causes brown age spots and freckles, but melasma patches tend to be larger. Patients with skin of color are more likely to have melasma form due to more active pigment-producing cells naturally occurring. 

How does the laser work for melasma? The 650-microsecond laser energy is absorbed by both epidermal and dermal melanin. The energy coagulates the excess melanin superficially. Then, deeper skin penetration targets dermal melanin. The laser energy also helps to reduce the inflammatory component of melasma by coagulating the microvasculature forming the pigment-forming inflammation.

What is Nevus of Ota and Ito? Nevus of Ota is a type of excess melanin formation that causes the hyperpigmentation of an eye and the surrounding area. It often takes the form of bluish or brownish pigment around the eye

Nevus of Ito is a colored birthmark that is usually slate-brown or blue/gray. It is an unusual birthmark in which the melanocytes are found deeper than normal in the skin. This type of birthmark is usually located on the shoulder and upper arm area on one side of the body. 

Nevus of Hori presents as asymptomatic blue- brown or slate-gray colored macules, located bilaterally on the face.

The conditions are more common in Asian and African skin, with females affected five times more than males.

How does the laser work for Nevus of Ota, Ito, and Hori? The 650-microsecond laser energy causes a photothermal effect on the excess pigment to selectively coagulate it at an epidermal and dermal level. The 650-microsecond laser is able to safely and effectively bypass the epidermis to address the dermal pigment found in these conditions.

What is onychomycosis? Onychomycosis, commonly referred to as nail fungus, is a  condition that involves a fungal infection of the fingernails or toenails. It commonly forms from trauma to the nail plate.

How does the laser work for onychomycosis? The 650-microsecond energy directly penetrates the nail bed to superheat the affected tissue, leading to fungal cellular damage and death. Due to the 650-microsecond laser energy deeply penetrating into the tissue,  even fungal infections affecting the nail matrix may effectively be cleared.

What is photodamage? Photodamage is a term describing skin changes such as fine and coarse wrinkles, roughness, freckles, and pigmentation changes that occur as a result of prolonged exposure to the sun. Black skin is more resistant to the deleterious effects of ultraviolet radiation than lighter skin types. However, photodamage is still persistent in darker skin types and commonly presents with pigmentary and textural changes. 

How does the laser work for photodamage? The 650-microsecond laser addresses skin quality, tone, and texture. The laser energy effectively coagulates excess melanin presenting as pigmentation. The laser energy also stimulates collagen production by bulk heating water in the dermis. The result achieves a smoother complexion and better overall skin quality.

What is post-inflammatory hyperpigmentation? Post-inflammatory hyperpigmentation is the temporary pigmentation that follows an injury to the skin or an inflammatory disorder of the skin, such as acne or psoriasis.

Post-inflammatory hyperpigmentation more frequently affects skin of color patients due to higher melanin production. PIH can have a significant psychosocial impact on skin of color patients, as these pigmentary changes can occur with greater frequency and severity in these populations and oftentimes appear more obvious in darker skin. It commonly occurs in more than 60% of the skin of color population.

How does the laser work for post-inflammatory hyperpigmentation? The 650-microsecond laser can prevent PIH formation by addressing inflammatory conditions such as acne and psoriasis. For existing cases of PIH, the laser energy coagulates the excess melanin and any remaining inflammation to create an even skin tone and complexion.

What is Pseudofolliculitis Barbae? Pseudofolliculitis Barbae, or PFB, is a type of folliculitis commonly affecting the beard area due to infection. PFB large affects skin of color, with a prevalence of 45% to 85% in black men, but it widely affects black women as well. There is a severe psychosocial impact on those affected by PFB. Hispanic men are the next most-affected group. PFB typically forms as a result of shaving when one has curly hair. The problem results when highly curved hairs grow back into the skin causing inflammation and a foreign body reaction.

How does the laser work for pseudofolliculitis barbae? The 650-microsecond laser energy helps patients affected by PFB in several ways. The laser energy can effectively destroy the hair follicle, removing the initial cause of the condition. For current cases of PFB, laser energy reduces the papules and pustules by suppressing inflammation. For PIH induced by PFB, the laser energy clears the hyperpigmented area.

What is psoriasis? Psoriasis is a chronic autoimmune skin disease that speeds up the growth cycle of skin cells, commonly creating thick patches of skin that can be painful, sore, and itchy.

Psoriasis is often more severe on skin of color. In 2011, the Journal of Drugs in Dermatology published a study of racial and ethnic variations among 2,511 psoriasis patients and found that Asians had the highest percentage of body surface area (BSA) affected at 41 percent, and Caucasians had the lowest at 28 percent.

Psoriasis presents differently in skin of color, which can make it difficult to diagnose. On Caucasian skin, psoriasis typically appears with erythema or red scaly plaques, but on skin of color, the discoloration is darker and thicker. Rather than being classically red, psoriasis in darker skin types can present as more of a purple or grayish color or darker brown.

How does the laser work for psoriasis? The 650-microsecond energy penetrates the thick plaque to suppress the inflammation and vascular components causing the cellular turnover. Once the inflammation is eliminated, any hyperpigmented areas can be treated by the laser, with the energy coagulating the excess melanin.

What is rosacea? Rosacea is a common skin condition that causes redness and visible blood vessels in the face. It may also produce small, red, pus-filled bumps. Persistent redness seen in light-skinned sufferers will have a more violet tone in skin of color and can be difficult to diagnose. Though flushing is not as apparent, skin of color sufferers describe a feeling of warmth on the face. Women are more likely to present with rosacea symptoms, and papules and pustules are usually present – more commonly so than persistent facial erythema.

How does the laser work for rosacea?  The 650-microsecond laser delivers laser energy to the inflammation and vascular tissue to effectively suppress the inflammation and coagulate the increased vascularity. 

What is skin rejuvenation? Skin rejuvenation commonly refers to facial aging, combining intrinsic or genetically determined and extrinsic factors including sun exposure, smoking, diet, and general lifestyle. The features of the aging face are well described and include loss of skin elasticity, lines, wrinkles, and vascular and pigmentary issues.

Overall, patients with skin of color have increased epidermal melanin and also a thicker dermis, thereby revealing less photodamage than lighter pigmented patients. Individuals with darker skin are overall thought to have firmer and smoother skin than individuals with lighter skin of the same age; however, aging does occur in regards to mottled pigmentation, wrinkles, and skin laxity.

How does the laser work for skin rejuvenation? The 650-microsecond laser addresses skin rejuvenation by correcting the visible signs of skin aging. The laser addresses water in the dermis to stimulate collagen to improve skin elasticity, laxity, and firmness to diminish fine lines and wrinkles. The laser addresses redness by coagulating vascular components, including microvasculature feeding inflammation. The laser also addresses melanin to coagulate excess pockets of melanin, to even skin tone.

What are traumatic scars and hypertrophic scars? Traumatic scars are skin changes caused by an injury, wound, poor healing, or previous surgery. In general, the darker the skin type, the more likely the body is to form a thicker, hypertrophic scar. Hypertrophic scars are characterized by vessel overgrowth that results in nerve fibers and collagen in the reticular layer of the dermis. This is believed to be caused by genetics, skin coloring, and the area of the body in which the scar is made. Earlobes, arms, the pelvic region, face, and collar bone are common areas for scarring.

How does the laser work for traumatic or hypertrophic scars? The 650-microsecond laser energy works by suppressing vascularization in scars, which feeds the scar growth. The laser also aids in collagen remodeling to help with the overall texture of the scar. 

What are under-eye circles? Under-eye circles present when the skin beneath both eyes appears darkened. It’s different from bruising around one eye from an injury or redness and swelling in one eye caused by an infection. The dark circles present as the pooling of blood under the eyes, primarily due to swelling of the tissue in the nasal cavaties.

How does the laser work for under-eye circles? The 650-microsecond laser energy reduces the vascular component and inflammation of the under-eye circles. The stimulation of collagen also helps to firm any skin laxity associated with the condition. 

What is laser hair removal? Laser hair removal of unwanted hair is the process of destroying the hair follicle to reduce unwanted hair from the body. Common areas of concern are the face, underarms, and bikini area. Both women and men commonly opt for laser hair removal to remove unwanted hair on the body. Patients commonly do so to reduce the need to shave, which may also cause issues more commonly seen in skin of color such as PFB, keratosis pilaris, and hidradenitis supperativa.  

How does the laser work to address unwanted hair? The 650-microsecond laser energy targets the melanin in the hair shaft to damage the hair follicle, effectively eliminating hair growth. The 650-microsecond pulse destroys the follicle, which prevents future hair growth. Hair must be in the appropriate growth phase, anagen, in order to be effectively destroyed, which is why it is common to have a number of sessions to achieve the desired percentage of reduction.

What are warts? Warts are growths on the skin caused by an infection with human papillomavirus, or HPV. The virus triggers extra cell growth, which makes the outer layer of the skin thick and hard in that area. While they can grow anywhere on the skin, they are most likely to get one on your hands or feet.

How does the laser work for warts? Warts are supplied by microvasculature. The 650-microsecond laser energy effectively coagulates the microvasculature supplying the wart, effectively closing off how the wart is able to survive. Once the microvasculature is coagulated, the wart will slough off the skin. 

Check out some of the combination therapies used to treat specific indications by practitioners:

Combination therapy is becoming widely respected as a way to boost results and achieve quicker clearance. Practitioners are starting to treat their patients with the most common traditional therapies in combination with laser energy for this reason. While in the past, laser energy was avoided due to risk of adverse effects, new 650-microsecond technology became the gold-standard because of how safe and effective it is on all skin types.


Start hydroquinone (no more than 6%) and non-hydroquinone blending products at home, follow with Jessner and salicylic acid peels and microdermabrasion, several treatments with 650-microsecond laser (low setting) for stubborn areas (3-4 weeks apart), sun protection.

Acne Vulgaris

Start with 650-microsecond laser weekly to clear cystic acid, then biweekly, monthly; patients happy with rapid clearance, then combination topicals; later treatment with 650-microsecond laser for PIH and scarring.

Postinflammatory Hyperpigmentation (PIH) (secondary to acne)

650-microsecond laser for quick clearance, tretinoin before and after 650-microsecond laser.

Postinflammatory Hyperpigmentation (PIH) (secondary to trauma)

650-microsecond laser in combination with chemical peels, test spot to win trust of patient.

Pseudofolliculitis Barbae (PFB)

Monthly 650-microsecond laser treatments, lower settings (2-3) if patient wants to keep hair; some passes directly on lesion, one additional pass for hair removal if desired.

Skin Rejuvenation

Full face with 650-microsecond laser (2-4 passes, more passes for darker areas). Combine with fillers and toxins for more even skin tone and less bruising.

*Among its 36 FDA cleared indications, the Neo Elite 650-microsecond laser is cleared for benign pigmented lesions, vascular lesions, and the coagulation of soft tissue.