Responsible Use of Energy-Based Treatments on Skin of Color: Eliot F. Battle, MD

Energy-based treatments and lasers for skin care have developed tremendously over the past decade, aided by the work of Eliot F. Battle, MD, a board-certified dermatologist, CEO and cofounder of New York Laser and Skin, and cochairman of the 2025 Skin of Color Update.

Battle’s research helped spearhead the development of safe and effective energy-based treatments, lasers, and tools for skin of color. He spoke at the 2025 Skin of Color Update on October 3, where he reiterated his pivotal innovations and research during a panel discussion titled “The Art of Treating Skin of Color with Lasers & Energy-Based Devices.”¹

In an interview with The American Journal of Managed Care^®, Battle addressed key differences in treatments between patients with skin of color and those without. He explained that the “bottom-up” approach—breaching the epidermis and treating the dermal layer of skin—is best suited for patients with skin of color, as trauma to the skin often presents as dark marks and hyperpigmentation more frequently in skin of color than in patients without.

Patients with skin of color are often referenced on the Fitzpatrick Scale—a numerical classification system to categorize skin types based on their reaction to ultraviolet rays—as either a 3, 4, 5, or 6.² However, during his panel discussion, Battle emphasized that while some skin of color may look alike, it doesn’t mean it should be treated the same.

He also said that skin of color is more sensitive to aggressive epidermal treatments like chemical peels. Even treatments for the dermal layer, like lasers, can sometimes be too harsh if used improperly, so Battle encouraged physicians to refine their knowledge of the tools they’re working with so they can provide safe and effective care.

“We look very similar, but boy, does our skin act differently. Every time you see a patient, don't assume, ‘I treated this skin color before; I can do this,’” he said. “Assume they're all different. Treat as conservatively as you can. Every patient is unique. We don't know the DNA of our patients. That’s the future of skin care; it’s going to be DNA-based.”

This transcript has been lightly edited. Captions are auto-generated.

Transcript

What did the state of skin care look like before recent technological advancements for patients with skin of color?

You know, 25 years ago, all we had were top-down approaches. We had products and prescriptions, bleach, and cream, and that's all we’d use, over and over again. Meanwhile, we were hearing all these great ads and recommendations for Caucasian skin with lasers and energy-based devices, and so we were very limited with our tools.

Most problems [in people with skin of color] are deep, and we're using topical tools and peels that would treat more topical skin. We didn't really have any approach to getting down deep [beneath the epidermal], and so lasers and energy-based devices brought on a whole new arena of safe and effective treatments for skin of color. And it's opened up the entire world to us in terms of getting treatments for acne scarring, skin tightening, hair removal, texture improvement, and pigment improvement. It's a very bright world [now].

How have you seen recent innovations improve treatments for patients with skin of color?

We can now do the same treatments we can do for Caucasians, so skin tightening, acne, scarring, hair removal—all those things everybody's seeking out, we can do, but we are also doing things with tattoo removal for people who are being targeted and abused.

There are a lot of things we're doing in terms of scar improvement. There are a lot of programs out here to help those people who really need our help. Most of them are free treatments for patients. And I think we apply this for the commercial side of things, but also try to get rid of as much as we can to help reduce some of the stigma that women and men are [experiencing] in the abuse world.

How do energy-based devices change the way you manage conditions in skin of color compared to traditional therapies?

When I became a dermatologist, 25 to 30 years ago, lasers were only for Caucasians. We couldn't treat skin of color, and I wanted to help if I could. I did wonderful research at Harvard for 3 years and a fellowship, and when I left, we could treat skin of color.

Our skin has 2 levels. The epidermis is my top level, and the dermis is my second level. The epidermis renews itself on its own every 6 weeks. If a dark spot were up there or if a scar were in the top layer, it'd be gone in 6 weeks. That's why scratches go away, but most of our stubborn stuff, our stubborn dark spots, and our scars are deep. And when we view the skin in 2 directions, [we assess] what treatments we can do top-down and what treatments we can do bottom-up.

Top-down is treated by peels, products, prescriptions, and bleaching creams. Bottom-up is treated with lasers and energy-based devices. Energy-based devices gave us access to the dermal issues, which are the vast majority of the stubborn issues we have to treat.

What recent innovations in energy-based devices show the most promise for treating pigmentary conditions, particularly in patients with darker skin types?

There's a new device out here that uses focal technology that minimizes heating on the epidermis and maximizes heating down deep. This is really revolutionary, because normally everything else is a beam that goes down so that epidermis is just as hot as the dermis, but this new focal point technology, which was invented by my colleagues at Harvard—my ex-boss at Harvard—I think, is going to revolutionize the way we approach the field, with acne scarring, texture, and skin tightening.

References

1. Cultura Cosmetic. Eliot Battle, Washington, DC: Arlington: Bowie: Dermatologist. CULTURA. February 24, 2025. Accessed October 9, 2025. https://culturamed.com/eliot-battle/

2. Ward WH, Lambreton F, Goel N, et al. Clinical presentation and staging of melanoma. In: Ward WH, Farma JM, eds. Cutaneous Melanoma: Etiology and Therapy. Codon Publications; 2017. TABLE 1, Fitzpatrick Classification of Skin Types I through VI. doi:10.15586/codon.cutaneousmelanoma.2017.ch6