Discoloration from Erbium Laser Resurfacing

Question

I am a 26 year-old-girl of Asian origin. I went to a doctor for chemical peels to treat my acne. I started seeing significant difference and wasn't getting as much acne as before. The doctor then recommended laser resurfacing for the acne scars, so I had Erbium Laser Resurfacing done around November last year.
My skin peeled heavily. I was applying a lot of sun screen during the day. My face looked smoother in 4 weeks, but I started to notice some slight discoloration on both my cheeks, on my nose, and some bit on my forehead. Some are brown patches while others are pink. I am trying to cover it with makeup but it does look awfully bad without any makeup.
My doctor told me to apply Retin A and Hydroquinone every night. I have been doing this for over 2 weeks now. The patches look a little lighter but not so light that I can walk around without makeup. I am definitely not happy with the results of laser resurfacing. What can be done to make these discolorations fade? Any help or suggestions would be greatly appreciated.

William Ting, MD · Answer

The risk of delayed postinflammatory hyperpigmentation is nontrivial for ethnic skin, e.g. Latino, Asian skin. Ideally, there should have been pre-treatment with topical retinoid and/or hydroquinone prior to laser resurfacing for ethnic patients. The good news is with appropriate medical treatment by a board-certified dermatologist experienced with ethnic skin, the pigmentation typically will improve in 2-3 months. Q-switched Nd:Yag laser such as Spectra laser can be considered as the new gold standard for post-inflammatory hyperpigmentation.

Joshua L. Fox, MD · Answer

It is not clear if you are having post-inflammatory pigmentation or less likely-a provocation of melasma. There are many excellent treatments which dermatologists know. These include topical creams with Berry, soy, azelaic acid, mild steroid creams, Vitamin C, Kojic acid etc.

David Goldberg, MD · Answer

This problem is known as post-inflammatory hyperpigmentation. It is a common problem when lasers are used too aggressively on Asian skin. The good news is that this problem will improve with time. The bad news is that it can take a long time to get better. 
There is a new treatment in our office that markedly hastens the lessening of this problem. This is known as Lumixyl Silkpeel. Lumixyl is a new compound that is a bleaching agent. It is stronger and safer than hydroquinones.  Generally, a series of 4-5 treatments done over a 2-month period will help you realize tremendous improvement in the problem.

Brooke R. Seckel, MD, FACS (retired) · Answer

From your history I assume you had flat beam Erbium laser resurfacing.
Newer fractional Erbium laser resurfacing is less likely to cause post inflammatory hyperpigmentation.
I agree with the use of topical bleaching regimes mentioned below and microdermabrasion.
If the pigment is not removed after 2-3 months of topical skin care there are other alternatives.
Low intensity non-ablative 1540 fractional Erbium treatments can help.

Discoloration from Erbium Laser Resurfacing

Answers (4)