Prolonged inflammation can lead to pigment changes

Mary Lupo, MD answers: Hypo-pigmentation After Fraxel Repair

I am 12 weeks post fraxel repair and still dealing with hyper-pigmentation issues that are slowly getting better. I recently got another opinion from another PS that is very experienced with CO2 lasers. I was there for another reason, so he was looking at my face with make-up; but, he said it looked like I was still dealing with some prolonged erythema and that the erythema could possibly lead to hypo-pigmentation. I understand that hypo-pigmentation is usually permanent. I am using Triluma for the hyper-pigmentation which tends to make my face more red. I'm so confused at this point. I do have some white patches that have been visible since the day after my treatment. I assumed they were areas that were skipped and never considered that they could be hypo-pigmented. Can hypo-pigmentation come on that fast? Should I lay off the Triluma until all of the redness goes away and then deal with the darker spots? While in the waiting room they had the Reliant video playing and it made my cringe. Their claims of "a few days of redness and no reports of delayed onset hypo-pigmentation" are ridiculous. There is no doubt I had some great improvement in some areas of my skin, but I feel like I traded them for other issues. I feel lucky that I didn't have more damage than I did.


Mary Lupo, MD
14 months ago

To really answer this question, I'd need more information about your skin type and the settings used for your Re:pair treatment. In general, the healing time for an aggressive Re:pair will be weeks and not days. The redness can last for 2-3 weeks routinely, but if it persists beyond that, the risk of prolonged complications exist. The Triluma is only good for HYPERpigmentation, and the tretinoin may be adding to the redness. I'd discuss the possible need for a very brief course of corticosteroid cream to act as an anti-inflammatory. Perhaps also a course of sub antimicrobial doxycycline and oral nicomide may be beneficial. Definitely see a dermatologist well versed in these pearls to treat resurfacing complications. Good luck.

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