Pigment Specific Lasers and Light Devices

Abstract

Laser treatment of pigmented lesions whilst challenging can be extremely rewarding, even in darker skin individuals when appropriate lesions are treated with the right laser and parameters. Proper patient selection, priming and adequate sun protection are essential prerequisites in the treatment of pigmented lesions and preventing recurrence following laser therapy. Accurate diagnosis of pigmented lesions is essential prior to initiating laser therapy. A skin biopsy must be performed in case of a diagnostic dilemma. Certain controversies exist in the treatment of pigmented lesions, for example, treating melanocytic naevi and treating patients taking oral isotretinoin. Further studies and consensus are needed to resolve these issues. Epidermal lesions need fewer sessions to clear, but are prone to recurrences. Shorter wavelengths such as 532 nm, 660 nm are recommended for treating epidermal lesions. Dermal lesions require more sessions to improve but recurrences are less likely. Longer wavelengths such as 1064 nm are preferable in the treatment of dermal pigmented lesions. Laser therapy is not the first choice for treating melasma and should only be undertaken in selected resistant cases that fail to respond to other treatments or are intolerant to topical medications. Evidence is emerging in favour of newer techniques such as combining laser wavelengths & laser toning. Treatments should be individualized based on patient skin type & lesional characteristics.