Section 4 Plastic and Reconstructive Problems

Laser Skin Treatment in Non-Caucasian Patients

routine should include keeping the skin clean and moist to allow for reepithelization and to minimize the potential of scarring. In general, chilled saline-soaked gauze is applied intermittently for the first several days. The treated area should be gently treated with a mild cleanser such as Ceta- phil, followed by the application of an oxygen- permeable ointment such as Aquaphor. Patients should be encouraged not to pull or pick at their skin as it starts to flake or peel, as this may in- crease the likelihood of scarring. Depending on the type of laser or resurfacing technique used, re- epithelization typically occurs within a week. Avoidance of sun and the liberal use of sunscreen should be encouraged. Patients should avoid the use of retinoids and other bleaching agents for risk of causing irritation. Most laser patients feel a sunburnlike sensation for the rest of the day after laser therapy. Topical skin care, oral analgesics, and cooling agents can all be used to improve patient comfort. Topical cooling agents, such as ice packs, are encouraged postprocedurally to improve patient comfort and decrease inflammation. Topical steroids may be considered in patients with persistent erythema. Careful patient selection combined with conserva- tive and judicious implementation of laser treat- ments can result in positive outcomes when dealing with patient of color and dark skin types. In this particular subset of patients, the most com- mon postprocedural concerns are related to dys- pigmentation and scarring. Postinflammatory hyperpigmentation is a com- mon occurrence with ablative laser options and is a bothersome side effect in darker phototypes (Fitzpatrick skin types V–VI) ( Fig. 4 ). 2,7 There are several options for topical therapies when consid- ering the treatment of hyperpigmentation, such as hydroquinone, azeleic acid, kojic acid, and embl- ica. Hydroquinone, a common treatment option, is a plant-derived tyrosinase inhibitor and is often used to treat discrete hyperpigmented patches. 4 Deleterious outcomes related to the use of hydro- quinone may include hypopigmentation surround- ing the treated area because of adjacent bleaching, in a halo effect. 2,10 Delayed hypopigmentation is a less common complication usually seen after ablative nonfrac- tionated laser resurfacing several months after treatment ( Fig. 5 ). This complication is permanent and a major cause for avoiding ablative nonfractio- nated resurfacing in dark-skinned patients. This condition can be confused with hypopigmentation POTENTIAL COMPLICATIONS AND MANAGEMENT

attributed to the use of retinoids and hydroquinone before laser treatment, which resolves with discontinuation of the medication. 10 In addition to dispigmentation after laser treat- ment, additional complications such as acneiform eruptions and HSV infections may occur in all skin types ( Fig. 6 ). 8 Acne eruptions are more common in patients with acne-prone skin and can be mini- mized by premedicating with oral antibiotics such as tetracycline. In general, prophylactic anti- virals are recommended in patients with a history of orofacial HSV. When treating patients with a his- tory of HSV outbreaks with laser exposure, antivi- rals should be started before the initiation of laser therapy and continued up to a week after laser application. Laser rejuvenation should not be per- formed on patients with active HSV infections. Although bacterial superinfections are uncom- mon, they should be treated aggressively to mini- mize scarring and dyspigmentation. 8,10 Bacterial Fig. 4. Posttreatment postinflammatory hyperpig- mentation. Postinflammatory hyperpigmentation is common with ablative lasers and may be reduced by using nonablative and fractionated techniques.

Fig. 5. Posttreatment hypopigmentation. Hypopig- mentation after laser therapy is a rare complication that may present several months after treatment.