Abstract

Objectives: To examine the role of neurocutaneous interaction in influencing variability in treatment response following EBD procedures in skin of color, and to propose an expanded clinical framework integrating both cutaneous and neurobiological determinants. Introduction: Energy-based device (EBD) procedures are widely used in the management of pigmentation disorders, acne, scars, and facial rejuvenation. In skin of color, however, treatment response remains variable despite appropriate device selection and parameter optimization. This variability is commonly attributed to melanocyte activity, baseline inflammation, and barrier vulnerability. Emerging evidence suggests that neurocutaneous interaction, mediated through the brain-skin axis, may represent an additional yet underrecognized determinant of treatment response in procedural dermatology. Materials / method: Relevant literature on the brain–skin axis, hypothalamic–pituitary–adrenal (HPA) axis activation, and neurogenic inflammation was reviewed and interpreted in the context of treatment response following EBD procedures in skin of color. Results: Reviewed evidence suggests that neurocutaneous signaling may influence key biologic pathways involved in post-procedural response following EBD treatment, including melanogenesis, vascular and inflammatory reactivity, barrier recovery, and wound healing. Stress-driven HPA axis and peripheral neurogenic activation may increase neuropeptides, cortisol-related mediators, and cytokines that alter healing. In skin of color, these mechanisms may increase susceptibility to PIH, delayed barrier recovery, and variable treatment tolerance despite comparable devices, settings, and indications. Conclusion: Treatment response following EBD procedures in skin of color is shaped not only by device choice and parameter settings, but also by the broader neurocutaneous context in which the skin responds. Recognition of these determinants may improve procedural planning, patient selection, and post-treatment care, while opening future directions for more integrated strategies that address both cutaneous and neuroimmune regulation.