How to Best Treat Indian, Latino, and Black Skin Tones

At the Society for Dermatology Physician Assistant (SDPA) 2025 summer meeting, Karan Lal, DO, FAAD, a double board-certified dermatologist, in Scottsdale, Arizona, presented on how to best treat darker skin tones, looking at patients who self-report as Indian, Latino, and Black. He shared common cosmetic surgeries for each ethnic group and what happens to each skin type as they age.

Lal talked about the 5 Fitzpatrick skin tones. Darker skin tones fell under Fitzpatrick types 3 – 5. Skin 3 typically describes Mediterranean and sometimes Indian skin; people with this skin can also be from southern Europe, central Europe, eastern Europe, America, and East Asia. In type 3, there is mild burning, tenderness, and skin irritation in sun-exposed skin that develops into a medium tan that becomes slightly darker in sun-exposed sites.

Skin 4 enters the “danger zone”—when skin is very reactive to heat and infrared. Indians often fall under Fitzpatrick type 4 and are prone to inflammatory hyperpigmentation.

“I'll say the truth. I never have a problem with black skin 6,” Lal said. “Two [of] my troublesome [patients] are the fours and fives because [the skin] just behave[s] very differently. Their melanin is so labile in their skin; it's very reactive…and so all of those things kind of influence how you can treat these people.”

Hispanic and Latino Patients

He first talked about Hispanic and Latino patients and how they span from Fitzpatrick types 2 – 5. Hispanics and Latinos tend to have wider bizygomatic distance, wider bigonial distance, a shorter chin, and more hypoplastic maxilla.

In this ethnic group, Lal said there is a lot of vanity in their culture. Many receive non-invasive facial aesthetic treatments. Research has shown that many people from Latin America prefer larger lips.

Lal addressed the importance of addressing bone health. If a patient has poor bone health, doing fillers will not help in the long run. Lal typically talks about bone health when patients reach 50 years old and recommends supplements for calcium, vitamin D, and collagen.

“A year later, the filler is gone because they're not addressing the underlying problem,” Lal said.

In the Hispanic and Latino population, rosacea is prevalent. Lal warns that laser treatments compete with hemoglobin, causing pigmentation.

“If you see a pseudo pigment network in that background of…vessels, they have vascular melasma,” Lal said. “You are not going to do a vascular treatment on that patient with a laser, like a pulsar laser.”

He added that more freckles on the palms can be an indicator of greater pigmentation. In this case, Lal said you should pre-treat and post-treat the patient. You should start slow with micro-needing, which has a low risk of pigmentation, or you can do a chemical peel.

Pulse dye laser can be harmful for darker skin tones (4 – 6), since these skin types have epidermal melanin that acts as a competitive chemophore against hemoglobin and oxyhemoglobin. This puts patients at risk of an epidermal injury, such as blistering, crusting, and resultant dyspigmentation.

Nd-Yag lasers are safer in darker skin tones, but are not safely designed. They have 2 settings, and if you accidentally use Alex (Alexandrite laser, 755 nm wavelength) it can lead to hyperpigmentation.

“The Alex and the Yag look very similar,” Lal said. “What ends up happening is a lot of people get treated with Alex in these dark presentations…so you have to check this out. I've done it when I was [a] resident [student]. I was…very confident.”

Lal recommends doing test spots, just in case. A test spot can protect you legally.

Asian Patients

Asians fall under the Fitzpatrick types 3 – 6. For Indians, chemical peels work well. The best treatment for hyperpigmentation in Indian patients is picosecond lasers at 532 nm, 755 nm, and 1064 nm.

These lasers are a lot faster than the thermal relaxation time for basal melanin, making it safer for patients of skin of color. They also have additional handpieces, including DOE, MLA, to let you use more energy.

Black Patients

In Black patients, pigment is a concern, but so are bony and soft tissue changes. This race has thicker skin and muscle, and more sagging in the mid and lower face. They may also have shadowing under their eyes, which many mistake for hyperpigmentation

“People are…getting filler to fix this shadow of the hyperpigmentation, but it's actually not just fat radiation,” Lal said. “So, if you see [shadowing], there are some radio frequency devices that you can use…. If it's something that you don't think you can provide a result for, refer them. They will be very happy because there's nothing that you can do, and I see it all the time.”

References

Lal, Karan, Cosmetics Track: Energy-Based Devices in Skin of Color: Optimizing Outcomes, Minimizing Risk. Presented at SDPA 2025 in Washington, DC on Thursday, June 26, 2025.