Laser and energy-based device use in skin of color: A clinical review of safety, efficacy, and best practices

Lasers and energy-based devices are integral to the management of dermatologic conditions, including pigmentary disorders, tattoo removal, vascular lesions, acne scarring, treatment of photoaging, and hair removal. In skin of color (Fitzpatrick types IV-VI), increased epidermal melanin acts as a competing chromophore with a broad absorption spectrum, increasing the risk of adverse effects such as post-inflammatory hyperpigmentation, hypopigmentation, blisters, and scarring. This review synthesizes current evidence on device selection, parameter optimization, and risk mitigation strategies to maximize safety and efficacy in this population. Low-fluence Q-switched and picosecond Nd:YAG lasers offer favorable profiles for pigmentary disorders and tattoo removal. Non-ablative fractional lasers can be used safely with conservative settings, whereas ablative modalities carry higher complication rates. Optimal outcomes require careful pre- and post-treatment considerations, including strict photoprotection and sequential, lower-energy treatments. Evidence gaps include a lack of large, prospective trials in darker skin types and standardized treatment parameters. Future research should prioritize inclusive study designs and pigment-specific protocols to improve safety, efficacy, and long-term outcomes in skin of color.