Vitiligo can be particularly noticeable and distressing in individuals with skin of colour due to the stark contrast between depigmented patches and surrounding healthy skin. Fortunately, 308nm targeted phototherapy is not only safe for people with skin of colour—it is often highly effective. However, the risk of perilesional hyperpigmentation (darkening of the skin around or within treated areas) is a real consideration that requires proper management.

Excellent Efficacy in Darker Skin Types

Research consistently shows that individuals with Fitzpatrick skin types IV–VI (tan to dark brown skin) respond very well to 308nm phototherapy. In fact, some studies suggest that higher skin phototypes may achieve more favourable responses compared to lighter skin types-56. The 308nm excimer laser has demonstrated notable success in promoting repigmentation in facial vitiligo, especially in patients with Fitzpatrick skin types IV–VI-7.

A large study of 979 Chinese vitiligo patients (predominantly skin types III–IV) confirmed that the 308nm excimer laser is both effective and safe in this population-54. Similarly, a prospective trial in Asian patients concluded that the 308nm excimer laser is "effective, relatively safe, and more convenient" for treating stable, localized vitiligo-56. These findings underscore that skin of colour should not be a barrier to accessing this treatment.

The Hyperpigmentation Risk: What You Need to Know

The same mechanism that makes 308nm phototherapy effective—stimulation of melanocyte activity—can also lead to unwanted darkening in darker skin types. Perilesional hyperpigmentation is a known side effect of targeted phototherapy--. This typically appears as a dark ring around the treated vitiligo patch or as dark spots within the repigmented area.

Importantly, this hyperpigmentation is usually transient. In most cases, it fades gradually after treatment completion or during maintenance phases. However, because darker skin contains more active melanocytes, the contrast between a repigmenting patch and the surrounding skin can sometimes be more pronounced during treatment.

How to Minimise Hyperpigmentation Risk

1. Start with Conservative Dosing

Darker skin types are more prone to post-inflammatory hyperpigmentation from any form of skin irritation. Therefore, starting with a lower initial fluence is essential. Many protocols begin at 100–150 mJ/cm² for skin of colour, with gradual increments based on individual tolerance-6. The goal is mild erythema (pinkness), not burning or blistering.

2. Avoid Overtreatment

Excessive UV exposure is the primary driver of unwanted pigmentation. Strict adherence to the prescribed dose and frequency (typically twice weekly) prevents cumulative overexposure. Never increase the dose on your own or treat more frequently than recommended.

3. Strict Sun Protection

Sun exposure before or after treatment compounds the risk of hyperpigmentation. Patients with skin of colour must use broad-spectrum SPF 50+ sunscreen daily on all treated and surrounding areas, even on non-treatment days. Physical sunscreens (zinc oxide or titanium dioxide) are often well-tolerated and effective.

4. Shield Healthy Skin

The 308nm device should be applied only to the depigmented patch, with careful shielding of surrounding healthy skin. In a clinical setting, technicians use opaque shields or precise handpiece placement to prevent "spillover" light.

5. Consider Combination Therapy

Adding a topical calcineurin inhibitor (e.g., tacrolimus 0.1%) or a low-potency topical corticosteroid can help modulate the local immune response and may reduce the risk of perilesional hyperpigmentation. Combination therapy also improves overall repigmentation rates.

What If Hyperpigmentation Occurs?

If you notice darkening around your vitiligo patches:

Do not panic. This is usually temporary and often resolves on its own within weeks to months after treatment adjustments.
Inform your dermatologist. They may reduce the dose, increase the interval between sessions, or prescribe a topical brightening agent (such as hydroquinone or azelaic acid) for the hyperpigmented areas.
Continue sun protection rigorously. Sunscreen is your best defence against permanent darkening.
Consider a treatment break. A short pause (2–4 weeks) allows the skin to "reset" and often reduces hyperpigmentation.

Yes, people with skin of colour can absolutely use 308nm phototherapy for vitiligo. In fact, they often achieve excellent repigmentation results. The risk of perilesional hyperpigmentation is real but manageable with proper dosing, meticulous sun protection, and close dermatologist supervision. When used correctly, the benefits of 308nm phototherapy—restoring pigment and improving quality of life—far outweigh the temporary risk of dark spots.

If you have skin of colour and are considering 308nm treatment, seek a dermatologist experienced in treating vitiligo in diverse skin types. They will tailor a protocol that maximizes repigmentation while keeping hyperpigmentation risks to a minimum.

Can People with Skin of Colour Use 308nm Phototherapy for Vitiligo? Addressing Hyperpigmentation Risks

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