Laser Hair Removal and Your Skin Type. Published in DermaScope Magazine in January of 2015

January 22, 2015

by Lisa Matire, L.E., C.C.E., C.M.E.

Understanding the Fitzpatrick Skin Type Scale for Laser Hair Removal

Dr. Thomas Fitzpatrick developed the Fitzpatrick photo typing scale in 1970. It is a convenient classification system involving the shade of the human complexion, reaction to the sun’s ultraviolet radiation, and cosmetic treatments. This helps ensure that we are treating our clients safely with the best efficacy.

There are six varieties of Fitzpatrick skin typing, ranging from extremely pale-skinned people who are highly subjective to burns, to extremely dark-skinned people who may suffer serious discoloration from laser or light treatments. To determine the Fitzpatrick skin type of a client, a variety of questions asked about genetic history, physical attributes such as eye color, hair color, and freckling, as well as client’s tolerance to the sun. Below is the scale developed by Dr. Thomas Fitzpatrick.

 

Skin Type 
 Typical Features 
 Reaction to Sunlight 
 I Pale white, milky, very fair skin; red or blonde hair; blue, green, or hazel eyes  Always burns, does not tan
II Fair skin; some freckles; blonde to light brown hair; blue or green eyes Burns easily, tans poorly
III Darker white skin; blonde or brown hair; dark blue, hazel, or brown eyes Rarely burns, tans well
IV Brown to dark brown skin; dark brown or black hair; brown eyes Rarely burns, tans very rapidly
V Dark brown skin; brown or black hair; brown eyes Very rarely burns, tans darkly
VI Black skin; black hair; brown or black eyes Never burns, always tans darkly, deeply pigmented

 

The Fitzpatrick skin typing is used to determine skin type for a variety of medical and cosmetic applications, particularly in laser treatments. Those with a higher level of skin type such as V or VI are usually prone to overactive production of melanin following laser skin or hair treatments. This can lead to pigmentation issues and/or scarring of the skin. You need to treat these clients with caution. On the other hand, skin type I to II is usually pale and likely to experience sun damage from ultraviolet exposure. Keep in mind you will have clients who have a mixed-skin complexion. It can be challenging to determine skin type. It is extremely important that you ask questions about ethnicity, as well as the skin’s tolerance to the sun to ensure you are treating these patients safely. Keeping all this in consideration and knowing your clients’ Fitzpatrick skin type number is essential for their skin’s beauty and health.

TREATING ALL SKIN TYPES FOR LASER HAIR REMOVAL

Knowing your clients’ Fitzpatrick skin type is one of the most important bits of information you need to determine before treating with any laser for hair removal. In general, laser hair removal depends on the skin/hair color, skin condition, sun exposure, and hair growth cycle. The results of laser for hair removal is still considered the best for fair skin and dark hair; however, treatments are becoming more and more available to all skin types I to VI. Keep in mind that laser light is absorbed easily by dark pigment. Black or brown hair, with the most amount of pigment, is considered the easiest to treat with fewer treatments. Light brown hair with less pigment requires more treatments because the lighter hair colors are more difficult to treat. Red and blonde hair creates a more difficult absorption for a laser light so it is harder to destroy its target.

Laser hair removal has become very effective in the past 10 years. The best candidate for laser hair removal will be the light-skinned with dark hair clients. African-American, Asian, Latin, and other ethnic groups with dark-to-darker skin tones used to be discouraged from choosing laser hair removal procedures. However, now with the Nd:YAG, we can treat all skin types safely. The laser emits a very specific beam of light at a wavelength that is targeted at melanin in the hair and/or at the hair bulb. Melanin is the material that gives color to hair, skin, and eyes. The Nd:YAG is a 1064 nm wavelength, long enough to bypass the melanin in the skin, allowing darker skin types to be treated safely with great efficacy.

Make sure to ask the right questions to determine skin type and background before treatment. If an incorrect setting/energy is used for the wrong skin type, it could lead to skin damage, scarring, hypo/hyperpigmentation issues, or an ineffective treatment. Besides the routine skin analysis, you need to ask the client what their response to ultraviolet radiation and their susceptibility to tanning and freckling without sunscreen, including any sunburn during childhood. Ask about any blistering after hours of sun exposure and about if they have had chemical peels and if so, what their skin’s reaction was. These are all important bits of information to help determine your client’s skin type.

CHOOSING THE CORRECT LASER FOR DIFFERENT SKIN TYPES

Laser and light-based hair removal utilizes wavelengths of light that targets pigment within the hair. The emitted light is absorbed by the hair pigment and converted into heat. Since the pigment in the hair is more abundant than it is in the skin, the thermal damage will target the hair while sparing the surrounding tissue. In general, when it comes to light absorption, the pigment in the skin competes with the pigment in the hair. Finding the appropriate treatment is challenging and depends on the type of the wavelength, treatment parameters, and the practitioner’s knowledge and skills. Listed below are several types of lasers/light-based technology that can be used for hair removal:

  • Alexandrite (755 nm) – This type of laser has a shorter wavelength, which is safe to use on Fitzpatrick skin types I, II, and III and even for Fitzpatrick IV, by increasing the cooling system.
  • Diode (810 nm) – This laser delivers a longer wavelength than the Alexandrite; however, shorter than Nd:YAG. This wavelength penetrates into the hair follicle with minimal side effects and/or epidermal injury. All Fitzpatrick skin types, including skin type VI, can use diode lasers.
  • Nd:YAG (1064 nm) – This laser emits the longest wavelength for hair removal. This wavelength is safe and effective on tanned or dark skin tones. It can penetrate three to five millimeters deep so it bypasses the pigment in the skin. This wavelength is cleared by the Federal Drug Administration (FDA) for treating all Fitzpatrick skin types.
  • Ruby (694 nm) – Best to treat Fitzpatrick I and II. They do not penetrate as deep as other lasers. Manufacturers ceased selling and marketing this type of laser.
  • IPL (515 to 1200 nm) – These are not lasers, but rather intense pulsating light. Different from a laser, which is monochromatic with one collimated beam, intense pulsed light (IPL) is not monochromatic. It is not collimated, and is therefore quick to spread out and makes this system less effective in the treatment of hair removal.

PRE-TREATMENT CLIENT INFORMATION

It is imperative that skin care professionals ask the correct questions to get an understanding of their client’s reaction to the sun and beauty treatments. Clients should be required to provide detailed information of their medical history, conditions, allergic reactions, medication, and history of temporary/permanent hair removal used. It is important to female clients if they are pregnant or planning on becoming pregnant, if they are breastfeeding, or take contraceptives.

Having clients sign an informed consent form at the time of the first treatment is crucial. Many practices also have a series of lifestyle questions that ask their clients each and every time they are treated. For example, the practitioner may ask the client about sun exposure or medication changes (to name a few). By having the client sign this form each time, they are confirming that the information collected is true and accurate. This is a way to avoid any lapse of communication between the practitioner and client.

RISKS AND SIDE EFFECTS

Aftercare is crucial for proper healing and minimizing the risk of any complications that may occur such as: edema and erythema; short term, mild burning sensations; temporary bruising and blistering; and allergic reactions.

POST TREATMENT

Immediately after laser hair removal treatments, it is common to see redness and bumps at the treated site. It is normal for the treated area to feel like sunburn for a few hours. Some skin care professionals recommend aloe vera gel or other after-sun treatments. Darker-pigmented clients may have more discomfort than lighter skinned clients. It is important to avoid sun exposure to reduce the chances of hypo/hyperpigmentation. Sunscreen of SPF 25 or higher should be worn after treatment.

The epidermis has the ability to heal itself; however, in the event of epidermal blistering, it is recommended not to apply makeup to the area. To minimize scabbing, it is important to avoid scratching or picking on the treatment site. Microdermabrasion, AHA, BHA peeling, or granule exfoliants should also be avoided directly after treatment. Clients may shower after their treatment by using gentle soap and warm water. They should pat the skin dry without rubbing. It is a must that they avoid Jacuzzis, public pools, and steam showers for 24 hours after being treated. It is important that clients understand that they need to follow these after-care instructions to avoid any problems after treatment.


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