Tinted Sunscreen Is Essential to Prevent Laser Treatment Complications in Skin of Color: Arielle Kauvar, MD

Patients should protect their skin from both visible and ultraviolet light by consistently using tinted sunscreen, especially before and after laser procedures, to prevent inflammation, hyperpigmentation, and other complications, said Arielle Kauvar, MD, director of New York Laser & Skin Care and clinical professor of dermatology at NYU Grossman School of Medicine, in an interview earlier this month at the Skin of Color Update 2025 in New York City.

Kauvar further discussed this topic at the meeting during her presentation,
"Navigating Laser & Device-Based Treatments in Skin of Color: Prevention & Management of Complications."

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

Transcript

What are the most common complications you see when using lasers in patients with skin of color?

The most common complications are probably hair removal, because hair removal is such a ubiquitous procedure. It could be related to a poor choice in laser. Certain wavelengths of light, the ones that are more strongly absorbed by melanin, such as an alexandrite laser, aren't suitable for treating skin of color because the absorption is too great.

Another factor would be using the wrong parameters, so too high in energy; anything that increases your absorption of the laser light can cause not only damage to the hair follicle but also damage to the epidermis and the surrounding tissue. With hair removal lasers, in particular, your target is melanin, or pigment. There's pigment in the hair follicle, but there's also pigment in the background skin. To protect that pigment, you want to use skin cooling.

Most of these lasers come with some cooling device, some that spray ice onto the surface of the skin, called cryogen, at the same time as a laser pulse. Others have what we call contact cooling. It's a cold tip, and it cools down the epidermis as you treat.

When complications do occur, what are your go-to management strategies?

It depends on the complication. Most of the complications, thankfully, are temporary hyperpigmentation or hypopigmentation. In those cases, with the hyperpigmentation, we'll usually give the patient corticosteroid cream as well as hydroquinone or another lightening agent to even out the skin coloring. If there's scarring from a procedure, which is a later event because you damaged tissue to the degree where you're blistered or ulcerated in an area, then you want to go to a resurfacing or rejuvenation laser. The lasers that are very safe for skin of color are the fractional nonablative lasers.

Fractional nonablative lasers, such as 1550 nm or 1565 nm, are lasers that make hundreds or thousands of little microscopic wounds in the epidermis and the dermis. As the tissue heals itself, it replaces the damaged epidermis as well as the damaged dermis, so there's new collagen and a new epidermis. In this way, you can improve scarring. We use these lasers for all kinds of scarring, not just for treating complications.

There's also another type of fractional, nonablative laser with a wavelength of 1927 nm that's specifically useful for pigmentation. It's a great option for all skin types, but what's important when you use these fractional lasers is to use a much lower density than you might in fair skin types and increase the treatment number. You want to induce less heating of the tissue because heat can stimulate melanin production, or new pigment production, and hyperpigmentation.

What role does patient education play in minimizing risks and setting expectations?

Patients need to know that the sun is their enemy, for all patients, not just those with skin of color. When you have inflammation in the skin, it's much more susceptible to getting hyperpigmentation, so it's important that the patient goes into the procedure at their baseline skin color. In some cases, if they're at high risk, we will pretreat them with skin lighteners, such as hydroquinone or others, and, in some cases, with the addition of a topical corticosteroid cream to minimize the inflammation. We'll also treat them after the procedure for a period of time for the same reason.

Using sunscreen all the time, and a physical sunscreen is best, leading up to the procedure and afterwards, to protect from the ongoing effects of both visible and ultraviolet light. It turns out that it's not only ultraviolet light that can stimulate pigmentation, but visible light can, as well. The only sunscreens that actually filter out visible light are the tinted sunscreens. Your best sunscreen for protection from hyperpigmentation or complications during a laser procedure is to use a tinted sunscreen.