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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.
POTENTIAL COMPLICATIONS AND
MANAGEMENT
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
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.
Laser Skin Treatment in Non-Caucasian Patients