Laser Treatment Approaches for Scars in Skin of Color

Conclusions

• Laser scar treatment is most effective when individualized to scar type, depth, location, tension, and skin type rather than using a single device or protocol for all scars.
• Combination therapy generally outperforms monotherapy, with common pairings including vascular lasers, fractional non-ablative or ablative resurfacing, picosecond platforms, radiofrequency microneedling, and adjunctive injections or topicals.
• In skin of color, safer and more effective outcomes come from using lower fluence, lower density, fewer passes, more cooling, longer intervals, and test spots to reduce post-inflammatory hyperpigmentation.
• Pulsed dye laser is particularly useful for erythematous and hypertrophic scars, especially when started early after injury and when combined with intralesional corticosteroid or 5-fluorouracil if needed.
• Non-ablative fractional 1550-nm treatments can significantly improve atrophic acne scars, post-inflammatory erythema, and some surgical or burn scars with relatively low downtime.
• Ablative fractional resurfacing can produce the greatest scar remodeling, but in darker skin types it must be used conservatively because the risk of adverse pigmentary effects is higher.
• Intralesional 5-fluorouracil appears to improve hypertrophic scars by reducing height and improving pliability while avoiding some corticosteroid-related atrophy.
• Newer focal-point or intradermally focused laser technologies may allow deeper targeted treatment with less epidermal heating, potentially improving safety in darker skin types.
• Hypopigmented scars and certain burn or traumatic scars may benefit from non-ablative or ablative fractional lasers, sometimes combined with repigmenting agents such as bimatoprost.
• Overall, earlier intervention and multimodal treatment lead to better scar outcomes than delayed or overly aggressive treatment, especially for newer scars and challenging scar subtypes.