The Red Is The New Black?

Rethinking Chromophores in Laser Treatments

In the glitzy universe of cosmetic dermatology, there's been a long-standing obsession with melanin, ever since the Fitzpatrick Skin Type strutted onto the scene in the 1970s. For about half a century, it's been all about melanin this, melanin that – focusing on treating the spotlight-stealing conditions like lentigos, melasma, and hyperpigmentation. It's like melanin has been the VIP at every skincare party, and everyone's been trying to figure out how to make this star guest happy.

But here's the twist: This melanin-centric saga has been sidelining two other crucial laser therapy VIPs – haemoglobin (the red) and water. Yep, these three – melanin (the black), haemoglobin (the red), and water – are the primary targets in the laser limelight. Whether it's a skin rejuvenation rave, sun spot soiree, acne scar after-party, or even the challenging melasma meet-ups, the success of a laser treatment is a choreographed dance with these chromophores.

Enter DALASS (Dr. Andy’s Laser Aggressiveness Scoring System), our game-changing method that's like the laser treatment equivalent of a cutting-edge DJ mixing deck. It helps laser technicians remix their settings by considering inflammation levels – a commonly overlooked skin condition. Think of inflamed skin like a partygoer who's had one too many and now radiates warmth (and not the good kind). This inflamed skin, with its elevated haemoglobin levels, draws laser energy like melanin, turning up the heat during treatments.

Now, while this heat is the life of the party in treatments aiming for collagen boosts (hello, rejuvenation and wrinkle-smoothing), it's a bit of a party crasher in conditions like melasma and PIH (Post-Inflammatory Hyperpigmentation). Here, cranking up the heat can stir up melanin's activity, potentially making things worse – like playing the wrong song at a dance party.

Emerging studies are spotlighting the role of vascular components in treating melasma. Yet, the cosmetic dermatology world is still jamming to the melanin-focused tunes. This approach can hit a dead-end, especially with melasma cases showing both epidermal and dermal pigmentation. Initially, treatments can make some headway with epidermal pigmentation, but the dermal pigmentation, hiding under layers of inflamed tissue, remains elusive.

So, we're calling for a remix in treating dermal pigmentation conditions like melasma. Instead of being a one-hit-wonder with melanin, a duet with haemoglobin is key. The new strategy? Tackle the redness (haemoglobin) first to cool down the inflammation. Then, move on to the pigmentation (melanin). By addressing the vascular component first, we can help the laser energy reach deeper melanin deposits and minimise residual heat, reducing the risk of those unwanted encore complications.

In conclusion, while melanin has been hogging the laser treatment limelight, it's high time haemoglobin gets its share of the stage. This balanced approach promises not only a chart-topping success in conditions like melasma but also a safer and show-stopping laser treatment experience. So let's hit the laser dance floor with a new rhythm!