Efficacy and Safety of a 650-Microsecond 1064nm Nd:YAG Laser in the Treatment of Keratosis Pilaris in Skin of Color

Authors:‍

M. Bhayana¹, H. Bui¹, C. Frey¹

¹Howard University Department of Dermatology, Washington, D.C., United States

Background and Objectives

Keratosis pilaris (KP) is a common, benign dermatologic condition characterized by follicular hyperkeratosis, often presenting with a rough, "chicken skin" texture. While primarily asymptomatic, its cosmetic appearance can lead to significant psychosocial distress. Numerous treatment modalities exist, yet achieving consistent therapeutic outcomes remains a challenge, particularly in individuals with skin of color. Laser and light-based therapies have demonstrated efficacy in treating KP, but their application in darker skin types presents risks, including post-inflammatory hyperpigmentation due to thermal injury. This study evaluates the efficacy and tolerability of a 650-microsecond 1064nm Nd:YAG laser (Neo Elite, Aerolase, USA) for the treatment of KP in patients with skin of color.

Methods

Three patients with Fitzpatrick skin types III–VI and a clinical diagnosis of KP underwent treatment with a 650-microsecond pulsed 1064nm Nd:YAG laser. Treatment areas were cleansed with alcohol before undergoing three laser sessions. A 650-microsecond pulse duration with a fluence of 14 J/cm² was used, delivering two passes in a crosshatch pattern per session. Post-treatment care included the application of petrolatum ointment and broad-spectrum sunscreen. Clinical outcomes were assessed using an investigator-blinded Global Assessment Score, evaluating improvements in erythema and hyperpigmentation at days 7 and 14. Patient-reported tolerability was recorded after each session, assessing parameters such as redness, dryness, peeling, burning, and itching.

Results

Blinded expert evaluation demonstrated a measurable improvement in KP severity. Erythema scores decreased by an average of 2 points, corresponding to a reduction from moderate erythema to near-clearance. Hyperpigmentation scores improved by 1 point, transitioning from moderate to mild over four weeks. Additionally, a decrease in perifollicular papules was noted, consistent with an overall reduction in KP severity. All patients reported complete tolerability, with no instances of redness, dryness, peeling, burning, or itching. Subjective assessments indicated noticeable improvements in skin texture. Importantly, no adverse effects, such as post-inflammatory hyperpigmentation, hypopigmentation, or bruising, were observed. Patients expressed high satisfaction with treatment outcomes.

Conclusions

The 650-microsecond 1064nm Nd:YAG laser is a safe and effective treatment option for KP in individuals with skin of color. The absence of adverse effects and significant clinical improvements suggest that this modality may offer a viable alternative for managing this condition. Further studies with larger cohorts and extended follow-up periods are warranted to validate these findings.