摘要

Objectives: 1 Identify optimal Fractional Laser (FL) selection and parameters for treating common dermatologic conditions, focusing on skin phototypes IV-VI 2 Evaluate broad spectrum applications including pediatric populations 3 Assess efficacy when FLs are applied as mono-therapy or in combination with other modalities Introduction: Fractional laser technologies aim at improving skin tone, texture, and pigmentation. Fractionated lasers based on principal of fractional photothermolysis are nonablative (NAFLs) generating microscopic photothermal zones and ablative (AFLs) inducing tissue evaporation. Ablative lasers have been considered more aggressive, necessitating longer downtime with higher risks for adverse reactions with particular challenges in skin of color (SoC) patients. Materials / method: A comprehensive literature search was conducted on PubMed. Of 1,065 articles were identified, and 40 articles met the inclusion criteria. The studies were classified based on design, dermatologic condition, and skin phototype of patients, and assigned levels of evidence according to the Modified Criteria of the Oxford Center of Evidence Based Medicine. Our search expanded in an additional arm with focus on pediatric population to assess FL applications under 18 years of age. Results: Treatment of melasma and atrophic scars using NAFLs was supported with strong level 1 evidence followed by moderate level 2 evidence for using NAFLs in acne vulgaris, striae, and skin rejuvenation. Data analysis showed 45% of the studies included skin types III-IV, 20% III-V, 7.5% II-IV, 5% II-V, 5% IV alone, and 2.5% I-IV. In pediatric populations both NAFLs and AFLs have been implemented; AFLs have been mostly implemented in combination therapies while NAFLs proved as safer. In our data in ages < 18 years, 32% of studies included darker skin type (IV-VI) . Conclusion: FLs remain very useful in SoC with NAFLs showing strong evidence of improvement of atrophic acne scars and melasma and moderate evidence in acne vulgaris, striae and skin rejuvenation. Microthermal zone density remains an important factor to control in skin types IV-VI, even in NAFL application. Combination therapies have been applied with better efficacy, decreasing need for multiple sessions in ages < 18 years. Additional research on FLs may substantiate optimal protocols while device selection with conservative settings and strict sun protection protocols remain crucial for optimal outcomes