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As the aesthetics industry continues to grow, clinicians must educate themselves regarding appropriate treatments and protocols for patients with skin of color to prevent adverse reactions. There is a lack of information for Fitzpatrick skin types IVVI, and increasing knowledge and skills is imperative for safe and effective treatments.

With exponential growth in the aesthetics industry, clinicians lack the equipment and knowledge to treat patients with darker Fitzpatrick skin types (FSTs) IV–VI. Such individuals have the highest risk for adverse skin events from aesthetic treatments. There needs to be more medical literature on the treatment of patients with FSTs IV–VI using laser therapy, chemical peels, and microneedling, with an imperative need for relevant studies. The current study’s findings, published in the journal Plastic and Aesthetic Nursing, relate to the appropriate protocols, treatments, and procedures for people with skin of color to prevent adverse reactions following aesthetic treatments.

Skin Differences in Individuals With Skin of Color

In the epidermis of people with skin of color, there is an increased number of cell layers and different melanogenesis, skin thickness, and melanogenesis compared to people with light skin, resulting in improved outcomes of topical and surface-level therapies. Thicker dermis in people with skin of color prevents accelerated skin aging; however, it increases the likelihood of hypertrophic scarring. Individuals with skin of color are more prone to post-inflammatory hyperpigmentation.

Skin Assessment of the Client

In addition to determining the FST of the client, the clinician should discuss with the patient any history of hypopigmentation or hyperpigmentation, ethnic origins, lifestyle, product use, and mixed ethnicities. This is helpful in identifying treatment outcomes and any adverse reactions.

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Chemical Peels for Pigmentary Disorders in Skin of Color

Patients with FSTs IV–VI suffer from pigmentary disorders, which can be treated using chemical peels; however, complications with chemical peels are relatively more common in people with skin of color. Clinicians should assess the client’s history and skin type in order to choose the correct chemical peel agent.

Intense Pulsed Light Precautions for Patients With Skin of Color

While performing intense pulsed light (IPL) therapy, clinicians should take precautions in patients with FSTs IV–VI. The use of IPL is not favored in these patients owing to the inability of the laser to distinguish between lesions and the client’s skin.

Safety of Microneedling in Skin of Color

Microneedling, or collagen induction therapy, has a good safety profile in patients with skin of color, owing to epidermis preservation and tolerability of microneedling in these individuals. However, patients undergoing this procedure might be at risk of post-inflammatory hyperpigmentation.

This review provided important treatment protocols and guidelines for performing aesthetic procedures on patients with skin of color; however, limited medical literature makes it imperative to conduct further studies on the safety and efficacy of aesthetic procedures in these individuals.


Amechi, M., & Halpin, J. (2023). Considerations for Laser Therapy, Microneedling, and Chemical Peels When Treating Patients With Skin of Color. Plast Aesthet Nurs (Phila), 43(1), 14-21. https://doi.org/10.1097/psn.0000000000000483