This clinical review brings together evidence on laser and energy-based devices in Fitzpatrick skin types IV–VI, where epidermal melanin competes with the target and raises the risk of post-inflammatory hyperpigmentation, hypopigmentation, blistering and scarring.
Its main conclusions are that low-fluence Q-switched and picosecond Nd:YAG lasers have favourable profiles for pigmentary disorders and tattoo removal, that non-ablative fractional lasers can be used safely with conservative settings, and that ablative modalities carry higher complication rates. Good outcomes depend on preparation and aftercare, strict photoprotection, and sequential lower-energy sessions rather than aggressive single treatments.
The authors state plainly that large prospective trials in darker skin are lacking and parameters are not standardised. For Indian practice, where most patients fall in these skin types and complications from aggressive settings are common, the review is a useful check on default parameters rather than a new protocol.
- Record Fitzpatrick type and any history of post-inflammatory hyperpigmentation before planning
- Test-patch at conservative settings before a full session
- Prefer 1064-nm Nd:YAG platforms for pigment and hair removal in darker skin
- Use conservative densities with non-ablative fractional lasers and avoid ablative resurfacing where possible
- Start photoprotection before treatment and continue it strictly afterwards
Why it matters
Most laser complications in darker skin come from settings designed for lighter skin.
Don't overread it
This is a narrative review; the evidence it summarises in darker skin is mostly small and unstandardised.
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