Gaps Remain in Research on Laser, Energy-Based Device Safety for Skin of Color: Arielle Kauvar, MD

Although significant progress has been made with laser and energy-based devices, Arielle Kauvar, MD, director of New York Laser & Skin Care and clinical professor of dermatology at NYU Grossman School of Medicine, emphasizes the need for more research on their use in patients with skin of color during the final part of her interview at the Skin of Color Update 2025 in New York City.

Watch parts 1 and 2 to learn more about common laser procedure complications in patients with skin of color and the safest devices for those with darker skin tones.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What key takeaways do you hope clinicians leave with from your discussion on navigating laser and device-based treatments in skin of color?

One is that you have to be familiar with laser tissue interaction. You can't buy a device and do a cookbook treatment from a menu; that's when you get into trouble. You have to be familiar with the safe parameters for the device, the safe energies, and the safe pulse durations. You have to understand the cooling and make sure the cooling is functional, if cooling is required for that procedure, to protect the epidermis.

Probably the most important, in addition to understanding how your laser works, is to be familiar with what we call "safe end points." For any given device, we want to look for a certain color change in the skin, or swelling, or redness. We don't want to see other types of changes, like blistering or severe pain, which are typically danger signs.

There's now a rich literature that's published specifically on knowledge about safe end points and also danger end points, so I think that's extremely important, especially when treating skin of color.

How has recent research improved our understanding of laser-tissue interaction in skin of color?

The basics of laser tissue interaction with all skin tones have been known for quite some time. In 1983, Rox Anderson, MD, at Massachusetts General [Hospital] and Harvard Medical School described this theory called selective photothermolysis. It describes the requirements for confining damage to a target without affecting the surrounding tissue.

Really, everything we do with lasers today is based on those concepts, but what's happened is not so much our understanding of what we can and can't do; it's more the advancements of the technology. For instance, the fractional lasers that I just mentioned didn't exist until 15 years ago. When we were treating scars or uneven pigmentation, they weren't available to us.

Similarly, all the colorblind devices, the radiofrequency and the radiofrequency microneedling, which are very popular today. The ultrasound techniques, so high-energy or high-intensity–focused ultrasounds, are used to stimulate collagen and help with wrinkles and tighten skin. You can use that very safely on all skin types.

I think it's more that we now have access to technological advancements that we didn't have in the past, but one thing is still missing. We don't have enough studies in skin of color. When lasers or other kinds of energy devices are first developed, for safety reasons, they're always tested on lighter skin tones. After that, it seems like most of them are tested on Asian skin types; there's a huge literature. The literature and the studies for Brown and Black skin are few and far between. I think with more studies and more data, we'll really be able to fine-tune what we do and perhaps push the envelope even more than we do now.