SAAM_2026_PIH_Deck

1.

SAAM CONFERENCE & EXHIBITION | 06-07 November 2026
Laser and Energy-Based Treatments
in Fitzpatrick Skin Types Three and Four:
Achieving Results Without Post-Inflammatory Hyperpigmentation
Dr. Iskandar Vaisov
Doctor of Science
Associate Professor, Tashkent State Medical University
CEO, Dr. Vaisov Laser Aesthetic Dermatology
Tashkent, Uzbekistan
Member of ASLMS, EADV
[ Portrait placeholder ]

2.

OPTICAL INJURY CONTROL
9
Control energy and fractional density
For 1550/1927 nm non-ablative fractional systems, lower pulse energy and/or density was associated with less PIH in comparative
studies.
HIGHER INJURY BURDEN
Illustrative pattern only -- not equivalent device settings
Goldman et al. Lasers Surg Med, 2026: review of 15 studies. DOI: 10.1002/lsm.70108
LOWER FRACTIONAL DENSITY

3.

CORE THESIS
2
PIH is a wound-response phenomenon
The clinical challenge is to preserve benefit while minimizing the melanogenic consequences of skin injury.
01
02
03
Laser, RF, inflammation, barrier
disruption
Keratinocytes + fibroblasts signal to
melanocytes
Epidermal melanin +/- dermal pigment
incontinence
INJURY
SIGNALING
KEY CONCEPT
It is not sufficient to target pigment while ignoring inflammation and repair.
Yadav et al. J Cutan Med Surg, 2026. DOI: 10.1177/12034754261427395
PIGMENT

4.

CLINICAL PHENOTYPING
3
Do not merge three distinct diagnoses
Similar colour does not mean identical pathophysiology or treatment priorities.
[ Clinical photo or schema ]
[ Clinical photo or schema ]
[ Clinical photo or schema ]
Post-inflammatory
hyperpigmentation
Melasma
Solar lentigo
Follows inflammation or procedural
injury. Track the injury trigger, erythema
and recovery.
Chronic relapsing disorder, influenced by
light, hormones and photoaged dermal
signaling.
Localized photodamage-associated lesion.
Procedure-specific PIH risk must still be
assessed.
Different endpoint - different risk calculus
Yadav et al., 2026; Kang & Picardo, Exp Dermatol, 2026. DOI: 10.1111/exd.70364

5.

FITZPATRICK III-IV
4
The dose-benefit window may be narrower
More epidermal melanin + individual inflammatory responsiveness = greater risk of dyspigmentation.
Competing chromophore
Phototype & baseline
pigment
Prior PIH / active
inflammation
Anatomic site + sun
exposure
Especially relevant when
wavelength is absorbed by
epidermal melanin.
Risk is not predicted by FST
alone.
Barrier status and erythema
matter.
Practical exposure changes
outcome.
DISCIPLINE Document risk modifiers instead of assuming a single safe setting.
Dreifus et al. J Am Acad Dermatol, 2026. DOI: 10.1016/j.jaad.2026.08.077

6.

MOLECULAR MECHANISM
5
From energy-induced injury to melanogenesis
A simplified paracrine cascade grounded in PIH pathophysiology.
TISSUE STRESS
KERATINOCYTE
MELANOCYTE
MITF -> TYR
Heat / injury / UV
IL-1 beta - PGs - ET-1
a-MSH / MC1R
Melanin synthesis
BASAL LAYER DAMAGE
Melanin enters the dermis -> Melanophages
Simplified conceptual illustration -- not a measured pathway in each patient.
Yadav et al., 2026. DOI: 10.1177/12034754261427395; Moon et al., 2025. DOI: 10.1111/pcmr.13207

7.

KOREAN MECHANISTIC EVIDENCE
6
NF-kB connects inflammation and pigment signaling
Proof of concept from Korean experimental dermatology -- not a patient treatment protocol.
Inflammatory
activation
MITF /
melanogenesis
NF-kB
Experimental NF-kB inhibition reduced inflammation and epidermal pigment in model systems.
STUDY DESIGN
PRECLINICAL
In vitro
Ex vivo human epidermis
Pigmented mouse models
Translation to patients unproven.
Do NOT recommend Bay 11-7082
for patient application.
Moon et al. Pigment Cell Melanoma Res, 2025. DOI: 10.1111/pcmr.13207

8.

HISTOPATHOLOGY
7
Why dermal PIH is often persistent
When melanin is deposited below the epidermis, a superficial-only strategy may miss the biology.
EPIDERMIS
95
DERMIS
biopsy-proven dermal
PIH cases
Pigment
incontinence
Melanophages (dermal pigment)
[ Schematic -- not a microphotograph ]
Observational anatomical measurement -- NOT recommended laser treatment depth.
Chung et al. J Cutan Pathol, 2026. DOI: 10.1111/cup.70216
295 um
median melanophage depth
from stratum corneum

9.

ADVANCED BIOLOGY
8
The dermis can sustain pigmentation
Key distinction: much of this evidence is from melasma / aging-related dyschromia, not laser-induced PIH.
SENESCENT FIBROBLASTS
BASEMENT MEMBRANE
VASCULAR & SEBOCYTE AXIS
Paracrine signals from photoaged dermis
Integrity of collagen IV / DEJ environment
Persistent signaling in melasma models
Clinical signal: 26-woman retrospective RF cohort + ex vivo markers; hypothesis-generating, not PIH prophylaxis RCT.
Kang & Picardo, 2026. DOI: 10.1111/exd.70364; Baek et al., 2026. DOI: 10.3390/ijms27020761

10.

TECHNOLOGY SELECTION
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Select the biological target -- not the brand
Evidence is indication- and device-specific; avoid untested combinations.
MODALITY
PRINCIPAL TARGET / LOGIC
CRITICAL SCIENTIFIC CAVEAT
1927 nm thulium
Superficial fractional water absorption
PIH possible; settings matter
1550 nm fractional
Deeper non-ablative remodeling
Risk depends on density and energy
1064 nm QS / ps
Melanin/pigment-directed effects
Avoid repetitive overtreatment
RF microneedling
Dermal heating + repair signaling
Evidence differs by indication
Ablative / 532 nm
Strong surface/pigment interaction
Higher vigilance for injury and PIH
Risk varies by device, indication, fluence, pulse structure, technique, anatomy and aftercare.
Dreifus et al., 2026; Goldman et al., 2026; Kim et al., 2026; Kang et al., 2024.

11.

TECHNOLOGY DEEP DIVE
11
1927 nm thulium: useful, not PIH-proof
Scientific appraisal of pigment and texture outcomes, including darker phototypes.
Systematic review 2025
17
448
studies
participants
Texture & photoaging
Pigmentary disorders
Phototypes III-VI
Supported in heterogeneous series
Improvement observed; recurrence can
occur
PIH rates vary; lower injury burden
favored
Caveat: many studies carry moderate-high risk of bias and protocols are heterogeneous.
Modena et al. Lasers Med Sci, 2025. DOI: 10.1007/s10103-025-04781-5; Goldman et al., 2026.

12.

KOREAN CLINICAL EVIDENCE
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RF microneedling: signal, not definitive proof
An option for selected dyschromia patients, with limits of retrospective evidence.
50
6.15 -> 3.75
patients | Melasma
Korean retrospective cohort, 2026
median mMASI, baseline -> follow-up
What the study can support
Limitations
Within-group improvement in melasma scores
Mild, transient adverse events in 12%
No randomized control group; treatment bias possible
Cannot claim prevention of laser-induced PIH
Kim et al. Aesthet Surg J Open Forum, 2026. DOI: 10.1093/asjof/ojag143; RFMN review 2026, DOI: 10.1093/asjof/ojag075

13.

RISK PREDICTION | KOREAN RCT
13
Persistent erythema and sunlight exposure matter
Procedure: Q-switched 532 nm for solar lentigines; findings are lesion-specific.
55.3%
31.0%
28 patients
67 lentigines
Risk correlates:
Erythema at week 2 (OR 1.32)
Daytime outdoor activity (OR 8.10)
Emollient
control
Triple-combination
cream from week 2
Single-center RCT. Do not extrapolate to other devices. p = 0.048 for TCC vs control.
Kang et al. J Dermatolog Treat, 2024. DOI: 10.1080/09546634.2024.2398768

14.

PREVENTION | EVIDENCE RECONCILIATION
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Avoid simplistic claims about prevention
Studies differ by design, endpoints and active comparator; photoprotection remains a clinical foundation.
2025 systematic review
2026 network meta-analysis
14 studies - 369 Asian cases
14 RCTs - 11 in network analysis
Photoprotection was the most consistent preventive measure
across included studies.
Some anti-inflammatory interventions ranked above sunscreen
alone; trial sizes and indirect comparisons limit certainty.
BOTTOM LINE
Individualize photoprotection, injury reduction and selected prophylaxis; avoid overclaiming.
Mar et al. Australas J Dermatol, 2025. DOI: 10.1111/ajd.14432; Wongdama et al., 2026. DOI: 10.1002/lsm.70098

15.

CLINICAL EXPERIENCE | TO BE DOCUMENTED
15
Clinical cases: show methods before outcomes
Use original consented, standardized photographs only. No invented settings or response rates.
CASE A
CASE B
BEFORE
photo required
FST: [verify] Indication: [verify]
Settings / sessions: [to insert]
PIH assessment / follow-up: [to insert]
FOLLOW-UP
photo required
BEFORE
photo required
FST: [verify] Indication: [verify]
Settings / sessions: [to insert]
PIH assessment / follow-up: [to insert]
Speaker-supplied, de-identified clinical documentation; evidence hierarchy: illustrative case is not a controlled trial.
FOLLOW-UP
photo required

16.

CONCLUSIONS
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Three clinical-scientific takeaways
Every intervention must be judged by benefit, biology and the durability of the safety outcome.
1
2
3
Risk begins with inflammation
Parameter discipline matters
Prevention evidence is evolving
Plan beyond pigment-selective
endpoints.
Avoid excess epidermal injury and
cumulative dose.
Combine photoprotection with
individualized care.
The goal is risk reduction with measurable clinical benefit -- never the promise of zero PIH.
Evidence synthesis: Yadav 2026; Dreifus 2026; Goldman 2026; Mar 2025; Wongdama 2026.

17.

SOURCE LIBRARY
17
References | 01 / 03
Peer-reviewed sources. DOI links for verification and slide attribution.
1. Yadav G et al.
J Cutan Med Surg - PIH pathophysiology review - 2026
DOI:
10.1177/12034754261427395
2. Dreifus EM et al.
J Am Acad Dermatol - energy devices in skin of color - 2026
DOI:
10.1016/j.jaad.2026.08.077
3. Moon J et al. [Korea]
Pigment Cell Melanoma Res - NF-kB / MITF experiment - 2025
DOI: 10.1111/pcmr.13207
4. Chung HJ et al.
J Cutan Pathol - 95 biopsy-proven dermal PIH - 2026
DOI: 10.1111/cup.70216
5. Kang HY & Picardo M
Exp Dermatol - melasma dermal field hypothesis - 2026
DOI: 10.1111/exd.70364
6. Baek Y et al. [Korea]
Int J Mol Sci - retrospective RF / ex vivo - 2026
DOI: 10.3390/ijms27020761

18.

SOURCE LIBRARY
18
References | 02 / 03
Peer-reviewed sources. DOI links for verification and slide attribution.
7. Goldman MP et al.
Lasers Surg Med - 1550/1927 FST III-VI - 2026
DOI: 10.1002/lsm.70108
8. Modena DAO et al.
Lasers Med Sci - 1927-nm systematic review - 2025
DOI: 10.1007/s10103-02504781-5
9. Kim HB et al. [Korea]
Aesthet Surg J Open Forum - RFMN, melasma - 2026
DOI: 10.1093/asjof/ojag143
10. Kang DH et al. [Korea]
J Dermatolog Treat - 532-nm PIH prevention RCT - 2024
DOI:
10.1080/09546634.2024.2398
768
11. Mar K et al.
Australas J Dermatol - PIH prevention SR - 2025
DOI: 10.1111/ajd.14432
12. Wongdama S et al.
Lasers Surg Med - RCT network meta-analysis - 2026
DOI: 10.1002/lsm.70098

19.

SOURCE LIBRARY
19
References | 03 / 03
Peer-reviewed sources. DOI links for verification and slide attribution.
13. Choi SM et al. [Korea]
J Cosmet Dermatol - split-face ECM after CO2 - 2023
DOI: 10.1111/jocd.15713
14. Passeron T et al.
J Eur Acad Dermatol Venereol - global consensus - 2026
DOI: 10.1111/jdv.70185
15. Kumar N et al.
Aesthet Surg J Open Forum - RFMN melasma synthesis - 2026
DOI: 10.1093/asjof/ojag075