Cosmetic lasers have many uses in correcting problems with skin pigmentation. In some cases, they are more effective than topical medications for restoring normal coloration. In others, they may be used in conjunction with creams or ointments to boost the overall effectiveness of treatment. However, there are some pigment disorders that aren’t necessarily responsive to laser therapy. Here are a few:

Moles

Dark brown moles (nevi) often fail to respond to laser therapy that is designed to fade pigment. Even if lightening is initially achieved, the pigmentation tends to return over time. Moles that are large, unsightly, or located in an inconvenient place on a patient’s body may be best dealt with via physical removal. This can be done surgically in a quick outpatient procedure that will leave a small scar. With atrophic scarring (the most common type), the color of the scar will fade from reddish pink to white over time. On patients with pale skin, the final result is typically less noticeable than a dark brown mole. The process of removing a mole is less expensive and time consuming than the multiple laser sessions that would be required to achieve significant depigmentation. Plus, a mole is extremely unlikely to grow back after excision.

Café au Lait Birthmarks

These pale brown birthmarks may respond unpredictably to laser treatment. A smaller mark may be a better candidate for laser therapy than a larger area of discoloration. Some patients experience darkening of the birthmark from laser treatment instead the lightening desired. Café au Lait spots are more common in African American patients – a demographic that tends to have mixed results with many treatments involving cosmetic lasers. A dermatologist with expertise in treating darker skin tones may be able to recommend lasers with the best track record for providing acceptable results,; but there are no guarantees of success.

Hyperpigmentation after Inflammation

For some individuals, skin that is healing accidentally overproduces melanin in the process. Post-inflammatory hyperpigmentation is a common problem in skin that has undergone a trauma such as a cut, abrasion, or burn. Rosacea, acne, and other skin conditions that cause inflammation can also cause dark spots on the skin. Cosmetic procedures such as chemical peels have been known to cause post-inflammatory pigment problems as well. Laser treatment re-traumatizes the skin, so it often ends up making the problem worse instead of better for these patients. Hydroquinone is typically prescribed as a more effective alternative for correcting pigment changes that are caused by inflammation.