Laser Resurfacing in Pigmented Skin

BACKGROUND: Laser skin resurfacing is a very promising new treatment for solar elastosis and acne scars. The Ultrapulse carbon dioxide (CO2) laser and the SilkTouch flashscanner allow precise depth control and char-free ablation. Earlier studies have been done mainly on Caucasian skin types I and II, but very little data were available on pigmented skin. OBJECTIVE: The purpose of this study is to assess the efficacy and safety of laser skin resurfacing in skin types III and IV. METHODS: Thirty Asian and Hispanic patients were treated for facial rhytides and acne scars. All patients were instructed to use tretinoin cream 0.05%, hydroquinone 5%, and desonide 0.1% cream nightly for 2-4 weeks prior to the laser treatment. The Ultrapulse 5000C CO2 laser with the Truespot 3-mm collimated handpiece at the setting of 250-450 mJ per pulse, or the Silk-Touch flashscanner at the setting of 5-7 W, 0.2-second pulse duration, and 4-mm (M) spot size, was used. Patients were evaluated clinically, and global response was assessed by both clinicians and patients. RESULTS: The facial rhytides and acne scars improved 25-50% in all patients after one laser treatment. The most common side effects were persistent erythema that resolved on the average of 6 weeks. Hyperpigmentation occurred, but was reduced with regular use of tretinoin, hydroquinone, and desonide cream both pre- and postoperatively along with use of broad spectrum sunscreen after treatments. CONCLUSION: Laser skin resurfacing can be used to treat facial rhytides and acne scars in skin phototypes III and IV. When proper pre- and postoperative management is implemented, the risk of dyspigmentation can be reduced.