The Asian patient with Fitzpatrick skin types III-V is rarely highlighted in publications on cutaneous disorders or cutaneous
laser surgery. However, with changing demographics, Asians will become an increasingly important group in this context. Although high
melanin content confers better photoprotection, photodamage in the form of pigmentary disorders is common.
Melasma,
freckles, and
lentigines are the epidermal disorders commonly seen, whilst
nevus of Ota and acquired bilateral
nevus of Ota-like macules are common dermal pigmentary disorders. Post-inflammatory
hyperpigmentation (PIH) occurring after cutaneous injury remains a hallmark of skin of color. With increasing use of
lasers and light sources in Asians, prevention and management of PIH is of great research interest.
Bleaching agents, chemical peels, intense pulsed light (IPL) treatments, and fractional skin resurfacing have all been used with some success for the management of
melasma. Q-switched (QS)
lasers are effective for the management of epidermal pigmentation but are associated with a high risk of PIH. Long-pulsed
neodymium-doped
yttrium aluminum garnet (
Nd:YAG) lasers and IPL sources pose less of a PIH risk but require a greater number of treatment sessions. Dermal pigmentary disorders are better targeted by QS ruby, QS
alexandrite, and QS 1064-nm
Nd:YAG lasers, but hyper- and
hypopigmentation may occur. Non-ablative skin
rejuvenation using a combination approach with different
lasers and light sources in conjunction with cooling devices allows different skin chromophores to be targeted and optimal results to be achieved, even in skin of color. Deep-tissue heating using radiofrequency and infra-red light sources affects the deep dermis and achieves enhanced skin tightening, resulting in eyebrow elevation, rhytide reduction, and contouring of the lower face and jawline. For management of severe degrees of photoaging, fractional resurfacing is useful for wrinkle and pigment reduction, as well as
acne scarring.
Acne, which is common in Asians, can be treated with topical and oral antibacterials, hormonal treatments, and
isotretinoin. Infra-red
diode lasers used with a low-fluence, multiple-pass approach have also been shown to be effective with few complications. Fractional skin resurfacing is very useful for improving the appearance of
acne scarring. Hypertrophic and
keloid scarring, another common condition seen in Asians, can be treated with the combined used of intralesional
triamcinolone and
fluorouracil, followed by
pulsed-dye laser. Esthetic enhancement procedures such as
botulinum toxin type A and fillers are becoming increasingly popular. These are effective for rhytide improvement and facial or
body contouring. We highlight the differences between Asian skin and other skin types and review conditions common in skin of color together with treatment strategies.