Hyperpigmentation 7 Weeks After CO2 Laser Removal of Sebaceous Hyperplasia

Question

I Am 7 Weeks Post Op for Co2 Laser Removal of a Sebaceous Hyperplasia Under my Right Eye. The settings of the laser were 1 pass, 4 watts P22. It was bright red 2 weeks ago and is now a darker red. My PS said it is not hyperpigmentation. I have used aquaphor, hydrocortisone 1%, hydrocortisone 2.5%, cutivate .05% and a pack of oral steriods. My PS will not prescribe Group 1 or Group 2 topical steroids due to thinning of the skin. His ARNP stated today that it will clear up with "time." I am not seeing much progress at 7 weeks and would like to know your opinion regarding this.

Raffy Karamanoukian, MD, FACS · Answer

Melarase AM and Melarase PM work well in our office to reduce pigmentation associated with aggressive laser treatments. Use the creams twice daily to acheive maximal response. Raffy Karamanoukian MD FACS

Jacob Sedgh, MD · Answer

Thank you for your question! There is always the potential for hyper or hypo-pigmentation with any ablative laser. Hyper-pigmentation can last a long time but it’s almost always temporary. It is best to follow up with your surgeon at this phase of recovery as there are pluses and minuses with topical steroids, as you have been instructed. We wish you the best!

Jeff Angobaldo, MD · Answer

Thank you for your question. It is common to have hyperpigmentation or even hypopigmentation after an ablative laser. I always recommend to pretreat with a lightening cream such as hydroquinone 2 weeks prior to the procedure to reduce the risk of hypo/hyper pigmentation. follow up with your provider.

Farhan Taghizadeh, MD · Answer

Hyperpigmentation is a common complication after fractional Co2 laser resurfacing. It is referred to as PIH or "Post inflammatory hyperpigmentation" and it can happen to any individual getting this treatment. Generally speaking, it will subside over time in my experience.Treatments for PIH that can be helpful are topical steorids, vitamin A derived skin care products (Tretinoin), and Hydroquinone. All these are included in a cream called Tri-Luma, which is my preferred topical for PIH.  One can prescribe these creams in various concentrations and formulations individually as well.Beyond topical agents and time, the other two treatments I have seen helpful are the use of pulse dye lasers and various types of Q-Switched lasers, the type that are used in tatoo removal. Here the physician experience and technology availability are very important.

Hratch Karamanoukian, MD, FACS · Answer

There is definitey hyperpigmentation following your procedure and proper care with products that are hydroquinone based and non-HQ based can help reduce this effect. I recommend Melarase AM and Melarase PM as well as protection from sun damage using Spectrase. Proper hydration and deep moisturization is also an essential component for the healing process (Elevase). Scler-X is a post inflammatory hyperpigmentation relief complex that I also recommend.

Hyperpigmentation 7 Weeks After CO2 Laser Removal of Sebaceous Hyperplasia

Answers (5)