Treating pigment in higher Fitzpatrick phototypes has long been a concern clinics decline. Dr Tego Kirnon-Jackman explains what changed, and why technology should be chosen by target rather than by novelty
Every technology decision in a clinic comes down to the same question: what is the target, and what will reach it without affecting everything around it. Anderson and Parrish set that out in 1983.¹ For vascular work; the answer is a wavelength oxyhaemoglobin absorbs at depth.² For acne, it is energy that reaches the sebaceous gland. Pigment is the concern where the answer has taken the longest to settle, and where getting it wrong is most visible.
Pigment is not one condition. Solar lentigines, post inflammatory hyperpigmentation and melasma behave differently and respond differently, and the first clinical decision is which of them is in front of you. The second is what the patient’s skin will tolerate.
Epidermal melanin absorbs energy across the visible and near infrared spectrum.⁴ In higher phototypes, greater epidermal melanin creates increased competition for optical energy, which can increase…
