New classification scheme for laser resurfacing and chemical peels: Modifications for the different ethnic groups

Abstract

Historically, classifications for laser rejuvenation and chemical peels of the skin are based on pigmentary color, with skin quality playing a less prominent role. Although useful in predicting aesthetic outcomes, these classifications do not, for the most part, take into consideration the patient’s origin and its associated relevance in predicting final results. Herein, a new classification system is proposed that not only takes into account skin color but also genetic predisposition as a key determinant of a patient’s response to skin injury, namely, laser resurfacing and chemical peels. This de novo classification takes into account both skin pigmentation and physical attributes in hopes of improving the predictability of patients’ response to skin treatments by physicians. Six categories are described: Nordic, European, Mediterranean, Indo-Pakistani, African, and Asian. The reactions of each category to peels, laser resurfacing, or dermabrasion are analyzed, and the potential risks associated with each group are noted. Most popular classifications [1–6] for patients undergoing chemical peels, laser resurfacing, or dermabrasion are based primarily on the color of their facial skin. The general tendency is to relate the result of a peel, dermabrasion, or skin resurfacing to skin color. It is generally accepted that the lighter the skin color and pigmentation, such as Fitzpatrick types I and II, the better the final result. The converse of this is also considered true: the darker the skin, such as Fitzpatrick types III to VI, the poorer the result. Skin color is often subdivided into categories: white, olive, tan, brown, yellow, and black. Classifications such as those of Fitzpatrick, Obagi, and Glogau, in addition to accounting for skin color, also account for certain characteristics (dryness, oiliness, thickness, and so forth) and the skin response to sun exposure. Those additional criteria are all valid and, to date, the ‘‘gold standard’’ has been the Fitzpatrick classification scheme. The physician, however, faced with a prospective patient, must evaluate multiple and, occasionally, contradictory factors. Traditional classifications, useful as they are, may sometimes be inadequate or confusing. They ignore a crucial factor: the patient’s racial origin, which is often associated with a characteristic skin color and almost always with characteristic features.