The 810 nm Diode Laser: A Safe, Effective Modality to Meet a Growing Population Need

By Eliot F. Battle Jr. MD

INTRODUCTION
For dermatologists who see patients of color in their clinics with increasing frequency as the years pass, the need for devices and techniques that are safe to use in this population may almost seem self-evident.1 Skin of color (SOC) does in fact pose special challenges and considerations, as due to its increased melanin content it behaves inherently differently from skin of lower Fitzpatrick phototypes.1

Although the situation is improving, dermatologists frequently find themselves faced with a lack of clinical data and trials specifically concerning skin of color.2 Not only has there previously been a lack of SOC patient representation in clinical trials, but darker-skinned patients themselves preclude their own treatment options by holding on to mistaken beliefs that laser treatments for procedures such as hair removal are not safe for them.3 Luckily, this is a misconception that effective management of new techniques and patient misconceptions can correct.

The Food and Drug Administration (FDA) has approved two systems for photoepilation in darker skin types: the diode 810 nm and the long-pulsed Nd:YAG (1064 nm).4 Both lasers utilize longer wavelengths, extended pulse durations and active epidermal cooling to provide the greatest efficacy and safety in treating skin phototypes IV–VI. To minimize epidermal thermal damage when treating darker skin types, pulse durations of 100 milliseconds or longer can be used with diode laser system.5

Epidermal thermal damage, post-treatment discomfort, erythema, edema, and irritation post laser treatment are a concern for patients of all skin types, but in patients with skin of color, side-effects can have especially pronounced manifestations in the form of dyspigmentation, scars, and blistering.5-7

The use of cooling devices,8 now available on most laser systems, greatly improves not only patient outcome but patient comfort during laser procedures. The use of appropriate lower fluences—although it may prolong the duration of treatment(s) overall—will build patient confidence as results in cases such as hair removal will be slow and gradual, with a sufficient safety margin to reduce many treatment-related adverse events (AEs).

SETTINGS AND METHODS
The 810 nm diode laser has seen marked evolution in ease and safety in treating skin types IV and V with features utilizing aggressive cooling, long pulse durations, rapid movement and pre-set treatment parameters.

A young Hispanic woman (Figure 1) with Fitzpatrick skin type IV was treated using an 810 nm diode laser (Soprano XLi®, Alma Lasers), which has pre-set parameters of how to treat various skin types. This device has evolved to determine essential laser parameters: fluence, total kilojoules, and the appropriate treatment time based on the patient’s skin type.

FIGURE 1. A young Hispanic woman with Fitzpatrick skin type IV was treated using an 810 nm diode laser

The area of treatment (underarms) was selected, along with the treatment size (150 cm). The device automatically selects the fluence per pulse (8 J/cm2), total kilojoules (8–10 kJ), and treatment time (80 seconds) (Figure 2).

FIGURE 2: The 810 nm diode laser automatically selects the fluence per pulse, total kilojoules, and treatment time.

When treating the underarm, the speed and technique are important. The diode lasers have evolved from the stamping the skin to either suction or waving pattern. Using a sweeping mode, up and down, at 10Hz per second, the physician gradually heats the epidermis to treat the dermal target without damaging the epidermis. Another important advantage to treating darker skin types is the ability to use a primary and secondary cooling device.

All lasers have evolved into rapid treatment machines, giving dermatologists the capability of spot treatment. The 810 nm diode laser has five degrees of contact-cooling and an apparatus that enables the physician to attach a Zimmer cooler as a secondary cooler. Not only does the cooling system improve safety in darker skin types, it also improves patient comfort.

CLINICAL BOTTOM LINE
When it comes to darker-skinned patients, it is important not to let mistaken patient pre-conceptions3 or restrictive cultural opinions and outdated practices9 govern what could be a very rewarding dermatological treatment result. Today’s lasers are innovative systems that depend on effective clinician-patient utilization to achieve the best possible outcome, and with a clearer understanding of the optimal settings for skin of color, the optimal results can now also be achieved in the skin of color population.

DISCLOSURES
The author has no relevant conflicts of interest to disclose.

REFERENCES
1. Chan HH. Special considerations for darker-skinned patients. Curr Probl Dermatol. 2011;42:153-159. Epub August 16, 2011.
2. Alexis AF. Skin of Color: Progress made, challenges remain. J Drugs Dermatol. 2011;10(5):459-460.
3. Vachiramon V, McMichael AJ. Patient knowledge and attitudes on laser hair removal: A survey in people of color. J Cosmet Dermatol. 2011;10(3):197-201
4. Battle E, Suthamjariya K, Alora M, et al. Very long pulses (20-200 ms) diode laser for hair removal on all skin types. Lasers Surg Med. 2000;12(suppl):21-24.
5. Battle EF. Advances in Laser Hair Removal in Skin of Color. J Drugs Dermatol. 2011;10(11):1235-1239.
6. Alster TS, Bryan H, Williams CM. Long-pulsed Nd:YAG laser-assisted hair removal in pigmented skin: A clinical and histological evaluation. Arch Dermatol. 2001;137(7):885-889.
7. Ismail SA. Long-pulsed Nd:YAG laser versus IPL for hair removal in dark skin. Br J Dermatol. 2011 Oct 16. doi: 10.1111/j.1365-2133.2011.10695.x. Epub ahead of print.
8. Manuskiatti W, Elmpunth S, Wanitphakdeedecha R. Effect of cold air cooling on the incidence of postinflammatory hyperpigmentation after Q-switched Nd:YAG laser treatment of acquired bilateral nevus of Ota like macules. Arch Dermatol. 2007;143(9):1139-1143.
9. Baldwin HE, Friedlander SF, Eichenfield LF, Mancini AJ, Yan AC. The effects of culture, skin color, and other nonclinical issues on acne treatment. Semin Cutan Med Surg. 2011;30(suppl 3):12S-15S.

About the author

Eliot F. Battle Jr. MD

CEO and Founder, Cultura Cosmetic Dermatology & Laser Center, Washington, DC

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