Recent advances in lasers for dermal pigmentation in skin of colour: An expert perspective

Background Dermal pigmentation disorders, including melasma, acquired dermal macular hyperpigmentation, dermal nevi, and post-inflammatory hyperpigmentation, are common causes of cosmetic concern in individuals with skin of colour (SoC). Their chronicity, propensity for recurrence, and increased risk of treatment-induced dyschromia make management particularly challenging. Over the past two decades, advances in laser technology have significantly expanded therapeutic options for these disorders. Objective To provide an expert perspective on recent advances in laser-based therapies for dermal pigmentation in SoC, with a focus on evolving technologies, combination strategies, and future directions. Methods A narrative review of the contemporary literature was performed, emphasizing studies evaluating Q-switched, picosecond, fractional, and combination laser approaches in dermal pigmentation disorders, particularly in patients with darker skin phototypes. Results The therapeutic approach to dermal pigmentation has evolved from conventional high-fluence Q-switched laser treatments to more selective and safer modalities. Low-fluence Q-switched Neodymium: Yttrium Aluminium Garnet laser toning improved the safety profile of pigment-specific lasers, while picosecond-domain systems enhanced photoacoustic pigment fragmentation with reduced collateral thermal injury. Fractional laser technologies, including ablative, non-ablative, and fractional picosecond platforms, have further expanded treatment options by facilitating pigment elimination and dermal remodelling. Emerging evidence also supports the use of sequential and combination laser strategies tailored to pigment depth and disease characteristics. Conclusion Recent advances in laser technology have broadened the therapeutic window for dermal pigmentation in SoC. However, recurrence and pigmentary complications remain important challenges. Future progress is likely to be driven by personalized treatment algorithms, multimodal laser strategies, and artificial intelligence-assisted treatment planning aimed at optimizing efficacy while minimizing adverse effects.