Q: Do you often do pre-treatment with topical medications before the laser therapy, especially when you treat darker skin types? I heard that it is better to use retinoid + hydroquinone for 6 weeks before the laser treatment because lightning of dark color background will minimize the risk of burn.
A: Practicing in South Florida, I see many patients with darker skin types seeking laser treatments. Whether treating for rejuvenation purposes or hyperpigmentation, I do typically recommend pretreating with hydroquinone for about 2 weeks prior to each laser session – particularly for skin types V and VI. I prefer to not pretreat with a retinoid because I like to ensure they have not used one at least a week prior to the treatment. Perhaps more important than pretreating these patients, however, is adjusting the laser’s settings to a lower fluence and/or a larger spot size for skin types IV-VI. A larger spot size allows light to penetrate deeper and helps limit injury to the epidermis and basement membrane which reduces risk of post inflammatory hyperpigmentation. Lower energy settings will limit risk of PIH as well as minimize any chance of burning or scarring the skin. To ensure an adequate treatment response in light of lighter settings, I usually recommend they come in for several more sessions than normal. Overall, becoming comfortable with each of your laser devices and their appropriate settings for darker skin is the key to successfully using lasers to treat a wide range of skin types.
Conclusion:
Pretreating patients with skin types V-VI with hydroquinone for several weeks prior to each laser treatment is recommended to reduce risk of PIH. For skin types IV-VI, adjusting the laser’s settings to a lower fluence and larger spot size is also strongly recommended.
