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Dermatol Reports. 2023 Dec 1; 15(4): 9703.
Published online 2023 May 19. doi:10.4081/dr.2023.9703
PMCID: PMC10777097
PMID: 38205425
Alhanouf Bin Dakhil,1 Asem Shadid,2 and Saad Altalhab1
Author information Article notes Copyright and License information PMC Disclaimer
Abstract
The CO2 laser has been widely utilized in dermatology; its expanding clinical applications include the management of neoplastic lesions, benign growths, cosmetic conditions, and reactive disorders. The laser’s popularity is mainly due to the high precision and short recovery time this technology provides. However, postinflammatory hyperpigmentation (PIH) has been one of the challenging adverse effects of the CO2 laser. Therefore, several modalities have been studied for the prevention of PIH following CO2 laser treatment. This review aims to analyze the incidence of PIH after CO2 laser therapy, identify its risk factors, and assess the efficacy of the examined treatment modalities in preventing PIH. Pubmed and Embase databases were searched for this study, and relative clinical trials were included in the review. Descriptive findings – including age, gender, skin type, types of intervention, and incidence of PIH – were reported. When appropriate, the incidence of PIH was compared across each possible individual factor, such as skin type, gender, and type of intervention. A total of 211 articles were identified, and 14 relevant articles were included in this review. Seventy percent of the subjects were females (n=219), and 30% were males (n=94), with a mean age of 30 years (SD=7.8). The most common skin types were type IV (59%) followed by type III (25%). In total, eight studies investigated the prevention of PIH. The incidence of PIH after CO2 laser significantly varies between studies and differs based on the type of intervention. The studies indicate that the use of Clobetasol propionate 0.05% and fusidic acid cream appeared to effectively reduce PIH, recording an incidence rate of 39% and 53.3%, respectively. The Fitzpatrick-skinphenotype did not appear to influence the risk of PIH. There is a lack of high-powered clinical studies analyzing the incidence of PIH after CO2 laser treatment and the associated risk factors. PIH occurrence may be related to inflammation resulting from thermal damage by the CO2 laser. Consequently, the use of postoperative topical medications with anti-inflammatory properties might reduce its incidence. The use of ultra-potent topical corticosteroids and topical fusidic acid appeared to reduce PIH, possibly reducing postoperative inflammation effectively. Similarly, platelet-containing plasma may be beneficial in reducing CO2 side effects, including PIH. However, more studies are needed to further establish the influence of skin type on PIH and investigate modalities to reduce PIH occurrence after CO2 laser use.
Key words: CO2 laser, postinflammatory hyperpigmentation, clobetasol propionate, fusidic acid, review
Introduction
With recent advancements in the field of dermatology, lasers have become an important and indispensable treatment modality with common application.1 One of the first lasers developed was the carbon dioxide (CO2) laser, which was created in 1964. Initially, the use of this particular type of laser was delineated to surgical procedures because of its high absorption by water.2 However, over the years, the CO2 laser’s usage has significantly expanded to include the treatment of both benign and malignant conditions, as well as cosmetic treatments and aesthetic imperfections. 1,2 This is primarily due to the high precision that the CO2 laser provides, in addition to the reduced presence of side effects like inflammation and slow healing.1
CO2 lasers are divided into two types: fractionated and unfractionated. Fractionated lasers are further separated into two subtypes: ablative and nonablative. Fractionated lasers, both ablative and nonablative, are considered safer than their nonfractionated counterparts due to their smaller columns’ microthermal zones. Nevertheless, both types can potentially lead to adverse effects, such as erythema and edema. Postinflammatory hyperpigmentation (PIH) is another side effect that is seen with the use of several different lasers, including CO2.1 This condition occurs due to hypermelanosis, which results from dermal inflammation. It is known to be the most common side effect of lasers in individuals with darker skin.3 Therefore, its occurrence in some geographic areas, such as the Middle East, is thought to be more common and severe.3 Although most cases resolve spontaneously, the duration of PIH varies depending on the patient, and the therapeutic options to accelerate its healing are very limited.1 Similarly, little is known about preventing PIH after laser treatment, especially CO2. To our knowledge, this is the first review to investigate the occurrence of PIH after CO2 laser therapy, as well as the efficacy of the available modalities in preventing this adverse effect.
Materials and Methods
A literature search on the PubMed and Embase databases was conducted from the first available date until 30/9/2021. Pre-identified search terms included “carbon dioxide”, “laser”, “resurfaces” “fractional”, “ablation”, “pigmentation”, “hyperpigmentation”, and “postinflammatory”. Inclusion criteria is comprised of prospective studies investigating carbon dioxide (CO2) lasers and addressing PIH. Case reports, case series, letters, comments, reviews, and non-English articles – or those that did not discuss carbon dioxide (CO2) laser or address PIH – were excluded.
Study characteristics were extracted, including authors’ names, year of publication, and study design; participants’ age, gender, and skin type; types of interventions to reduce CO2 side effects; and study outcomes. First, descriptive findings, including age, gender, skin type, types of intervention, and incidence of PIH were reported. When appropriate, the incidence of PIH was compared across possible influencing factors, such as skin type and method of intervention used to reduce PIH.
Results
Our search revealed a total of 211 records (Appendix 1). After removing duplicates, title and abstract screening were performed and led to the exclusion of 118 records. Full-text screening of the remaining 24 studies was thus completed. Ten records were further excluded for the following reasons: one study did not address PIH;4 another study did not involve CO2 laser;5 others were a case report,6 and a review article;7 and six studies were retrospective analyses (Figure 1).8-13 After these exclusions, fourteen studies met the inclusion criteria. The characteristics of the included studies are shown in (Table 1). The studies included 313 participants, with a ratio of 70% females (n=219) and 30% (n=94) males. The age was recorded in 273 subjects, with a reported mean age of 30 years (SD=8.1). Fitzpatrick skin phototypes were reported individually in 259 participants. The most common skin type was type IV (n=164, 59%) followed by type III (n=70, 25%) (Table 2). The overall incidence of PIH after CO2 laser treatment significantly varies between the studies, ranging from 0% to 100%. The incidence of PIH differs based on whether a medical intervention was used to decrease side effects of CO2; it is also dependent upon the type of the intervention. Eight studies including 258 participants examined the efficacy of medical interventions in the prevention of PIH.3,11,14-19 These include the topical use of Fusidic acid compared to topical erythromycin (n=60);14 clobetasol propionate 0.05% compared to petroleum jelly (n=40);3 an experimental moisturizer containing 5% panthenol, madecassoside, and copperzinc- manganese (PMCZ) compared to triamcinolone acetonide 0.02% (n=20);16 MAS063DP (Atopiclair) cream compared to triamcinolone acetonide 0.02% (n=16);19 platelet-poor plasma gel compared to saline (n=36),11 platelet-rich plasma (PRP) (n=30);17 epidermal growth factor compared to petroleum jelly (n=19);15 and multi-growth factor (MGF)-containing cream compared to placebo (n=20).18 Six studies did not use any adjunctive or postoperative interventions.20-25
Topical corticosteroids were used by three studies.3,16,19 This involved an ultra-potent corticosteroid (clobetasol propionate 0.05%), and a mid-strength treatment (triamcinolone acetonide 0.02%), either as an experimental intervention or as a control. When topical clobetasol propionate 0.05% was used, the incidence of PIH was 39%.3 However, the PIH incidence was with triamcinolone acetonide 0.02% was 55% and 43.7%.16,19 Topical antimicrobials, fusidic acid cream erythromycin ointment, were examined by one study.14 The incidence of PIH with fusidic acid cream was 53.3%, while it was 91.1% with the use of erythromycin ointment. What’s more, PIH incidence was 52.6% with topical epidermal growth factor, and 60% with the use of PMCZ.26 With MAS063DP, the incidence of PIH was recorded in 50% of the participants.19 Two studies examined concurrent injection of platelet-containing plasma.11,17 With PRP, the incidence of PIH was only 16%, while it was 36% with platelet-poor plasma injection. The incidence of PIH based on gender and Fitzpatrick skin phototypes (FSP) were reported in 101 subjects. Ultimately, the difference in PIH incidence based on skin type was not significant in any study.
Figure 1.
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Diagram of the included studies.
Table 1.
Characteristics of the included studies
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PIH, postinflammatory hyper pigmentation; PMCZ, 5% panthenol, madecassoside, and copper-zinc-manganese; PRP, platelet-rich plasma; NR, not reported; NA, not applicable.
Table 2.
Fitzpatrick skin phototypes.
Type | N (%) |
---|---|
Not reported | 18 (6.5) |
Type I | 3 (1.1) |
Type II | 6 (2.2) |
Type III | 70 (25.3) |
Type IV | 164 (59.2) |
Type V | 16 (5.8) |
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Discussion
The development of PIH after CO2 laser treatment has been postulated as a melanocyte response to inflammation, resulting from the thermal damage caused by irradiation.3 During the inflammatory phase, prostanoids, cytokines, chemokines, and other inflammatory mediators lead to the overproduction of melanin by melanocytes. This melanin is then transferred to the surrounding keratinocytes, thus leading to irregular dispersion of pigment.3,27 Nonetheless, the fundamental processes in the development and variability of PIH in individuals are not fully understood – particularly the risk factors for the occurrence and severity of PIH. Some theorists propose that PIH incidence is somewhat related to the functionality and ability of an individual’s melanocytes to respond to inflammation with hyperpigmentation. In this assessment, they refer to the patient’s melanocytes as “weak” or “strong”.3,28 In this review, the incidence of PIH after CO2 laser therapy significantly varies in the included studies, between 0% to 100% occurrence.
It has been proposed that PIH is mostly observed in people with darker skin, hastily linking this occurrence to Fitzpatrick skin phototypes.1 However, it must be noted that none of the included studies found a significant difference in PIH incidence among the participants based on FSP. The incidence was reported to be 0% in the Tan et al. study, in which all participants (n=7) had either FSP IV or V.22 In fact, the authors suggested that FSP IV and V carry a lower risk of the development of PIH after CO2 laser treatment. On the other hand, all of the participants (n=40) in Cheyasak et al.’s study had FSP IV, and the PIH incidence was as high as 75%.3 The highest reported incidence of PIH (100%) was reported by Alster et al.; in this case, all the participants (n=7) had either FSP I or II.20 Conducted by Wei et al., the study with the largest sample (n=60) reported FSP types ranging from III to IV, with a total incidence of PIH being up to 90%.14 Lastly, Lueangarun et al. reported that in their study, the incidence of PIH in FSP III and IV was identical (50%).19 These findings indicate that FSP might not be an independent risk factor for the development of PIH following CO2 laser therapy. However, it should be noted that the inconsistency of these findings has three possible roots: the variation sample size, different PIH evaluation modalities, and the lack of individual PIH reporting based on FSP by all studies. Further studies are necessary to determine the relationship between skin phototype and PIH. The treatment of PIH is broadly challenging and requires patience and compliance. Some treatments – such as topical hydroquinone, tretinoin, glycolic acid, and vitamin C – have been used to remedy this skin reaction. But when PIH occurs, it may last for several months regardless of the use of treatment.3,29,30
Therefore, the use of perioperative and postoperative therapies to prevent PIH in dermatologic procedures is viewed as a possible way to overcome this common complication. However, the evidence is still developing. Eight of the included studies examined the efficacy of off-label or investigational use of several treatments in the prevention of PIH after CO2 laser use.3,11,14-19,22,24 Among these treatments are topical corticosteroids, antimicrobials, topical growth-factors, and experimental therapies.
Topical corticosteroids
TC reduce inflammation by inhibiting phospholipase A2 and delaying the release of arachidonic acid from the cell membrane. Because of PIH’s inflammatory nature, the use of TC after CO2 lasers has been proposed as a potential preventative modality to decrease the risk of PIH. Takiwaki et al. have previously demonstrated that topical clobetasol propionate and hydrocortisone butyrate decrease the incidence of UVB-induced hyperpigmentation. 31 Topical corticosteroids (TC) after CO2 laser therapy was described in two of the included studies.3,16 Cheyasak et el. compared clobetasol propionate 0.05% ointment to petroleum jelly. In this comparison, they found that the use of clobetasol propionate 0.05% significantly decreased PIH incidence to 39%, compared to 75% with petroleum jelly (p<0.001). This finding supports the theory that controlling inflammation at earlier phases may reduce potential consequences like PIH. On the other hand, Lueangarun et al.16 investigated the effect of PMCZ cream on the incidence of CO2 laser-related side effects. As a comparative tool, they also used triamcinolone acetonide 0.02% cream. The study reported that PIH was recorded in 55% of triamcinolone acetonide 0.02% group participants, compared to 60% with PNCZ cream. In another study by Lueangarun et al.,19 PIH with the use of triamcinolone acetonide 0.02% was recorded at 43.7%. Upon studying these results, it is possible that PIH incidence with triamcinolone acetonide (55% and 47.3%),16,19 compared to clobetasol propionate (39%)3 could be related to the corticosteroids potency. Clobetasol propionate 0.05% is an ultra-potent TC; meanwhile, triamcinolone acetonide 0.02% is regarded as a mid-strength TC.32 Thus, it might be reasonable to postulate that the incidence of PIH with clobetasol propionate 0.05% was lower because of its more potent effect in reducing inflammation. Lueangarun et al.16 reported that PMCZ cream was not superior to triamcinolone acetonide 0.02% in reducing CO2 laser postoperative downtime; however, both regimens reduced redness and swelling. Nevertheless, PMCZ is still a novel experimental moisturizer, and its anti-inflammatory properties have not yet been adequately studied.
Topical non-steroidal anti-inflammatory drugs
MAS063DP lotion is a non-steroidal anti-inflammatory moisturizer typically used to treat different forms of dermatitis. Lueangarun et al.19 used MAS063DP lotion (Atopiclair® brand lotion) after CO2 ablation, in an effort to assess its ability to prevent PIH. The study found that MAS063DP was not superior to triamcinolone acetonide 0.02% in reducing the incidence of PIH after CO2 ablation (50% vs. 47.3, respectively). The results of this study may endorse the theory that the preventative agent’s antiinflammatory potency is an important factor in controlling PIH. This is supported by the fact that clobetasol propionate 0.05% appeared to successfully reduce PIH, in contrast to triamcinolone acetonide 0.02% and MAS063DP.
Antimicrobials
The use of topical antimicrobials after laser therapy treatment has been described in the past; however, its effect on PIH development has not been completely established.33 This rule was examined by Wei et al.,14 and included the use of fusidic acid cream or erythromycin ointment. The authors reported a statistically significant difference in the incidence and severity of PIH with the use of fusidic acid cream compared to erythromycin ointment (p<0.05).14 Fusidic acid cream (53.3%) appeared to effectively reduce PIH after CO2 laser therapy more than erythromycin ointment (93.1%). Fusidic acid is the only approved topical antibiotic from the fusidane family.26 The product has some anti-inflammatory properties, such as inhibiting proinflammatory cytokines of TNF-α, IL-1β, and COX-2.26 The findings by Wei et al.14 might be due to the fact that fusidic acid reduces postoperative inflammation, and therefore decreased PIH. Nevertheless, more studies are needed to determine the influence of fusidic acid on PIH.
Platelet-containing plasma
Platelet-containing plasma either PRP or platelet-poor plasma – has been used in conjunction with CO2 laser therapy. Two studies have demonstrated this treatment’s efficacy in reducing CO2 laser side effects. Gad et al.11 reported that PIH after CO2 laser therapy significantly decreased with the use of platelet-poor plasma (p=0.021). Furthermore, the incidence of PIH after CO2 laser treatment was only 16.6% with the use of PRP. The decrease of PIH with platelet-containing plasma could be attributed to its stimulation effect, which impacts the extracellular signal-regulated kinase and the suppressive effect of TGF-β1 on melanin synthesis.11,34 This is in addition to the basem*nt membrane repair effect by platelet degranulation, and the release of laminin, collagen IV, and tenascin.11,34
Epidermal growth factor
Epidermal growth factor (EGF) plays a crucial role in the wound healing process; yet its external use in the clinical setting has not been well established. Nevertheless, some studies examined the effect of topical EGF on prompting wound healing in acute tissue injuries – such as radiation-induced mucositis – and received positive results.35 Techapichetvanich et al.15 evaluated the effect of topical EGF on PIH prevention after CO2 laser therapy. However, the study did not find a statistically significant difference in PIH occurrence with the topical application of EGF. The authors proposed that the positive effect of EGF application on reepithelialization might be more observed in cases of chronic wounds, rather than post-laser wounds.15 These findings are in agreement with those reported by Shin et al.18 who did not find significant differences in the incidence of PIH with the multigrowth factor-containing cream compared to the placebo cream.
Bleomycin solution
In their study, Suh et al.24 used bleomycin solution after CO2 laser therapy while treating periungual warts. The objective was to evaluate the efficacy and safety of bleomycin solution for treating periungual warts; however, the authors noted that PIH occurred only in one patient with this treatment (5.8%). No other studies examined the effect of bleomycin solution in reducing PIH or inflammation after CO2 laser therapy. Bleomycin is an antitumor agent with antibacterial and antiviral properties. It has been widely used as primary or adjunctive therapy for various cutaneous conditions.36 This agent’s effect on inflammation have yet to be established, and one of its common side effects is inflammation at the application site. Currently, there is not sufficient evidence to support the use of bleomycin solution to reduce PIH after CO2 laser therapy.
Hormonal changes
The effect of hormonal changes on the occurrence of PIH is an under-studied idea. Although most PIH occurs in women, it is likely related to the fact that females undergo laser therapy more often than men. Almohizea investigated the effect of the menstrual cycle on CO2 laser-induced PIH.21 The author found that PIH was more severe when CO2 laser therapy was performed during the patient’s menstrual cycle. Despite the limited sample size (n=7), the study’s findings are highly interesting. Pigmentary conditions, such as melasma, correspond with hormonal changes – those associated with pregnancy and the use of contraceptive medications. It is unclear if PIH severity in Almohizea’s study was related to the inflammatory response being affected by menstrual cycle, or if the melanocytes reaction is “strong”, as described by Ruiz-Maldonado, during this phase.28 Puder et al.37 reported that menstrual cycles are associated with changes in plasma inflammatory markers, suggesting that menstruation is linked to low-grade inflammation. The relation between inflammatory response after CO2 laser therapy and the menstrual cycle begs further elaboration.
Limitations
Data was reported in a cumulative pattern by many studies, rather than for each participant individually. As a result, evaluating each possible risk factor of PIH using multivariable regression analysis was not viable. Therefore, it was not possible to determine if each factor – such as skin type and type of intervention – were independent of the other factors, such as gender and age. Additionally, the incidence of PIH might also depend on other medical and technical factors, such as the dermatological condition being treated, energy and density of the laser therapy, and sun exposure before and after treatment. This may have led to the variable incidence of PIH reported in the literature. Robust clinical trials with extensive, detailed documentation are needed to properly assess the risk of PIH after CO2 laser therapy and determine the efficacy of preventative modalities.
Conclusions
CO2 laser therapy is widely used in the field of dermatology due to its high precision and short postoperative downtime. However, PIH remains a challenging adverse effect that is frequently observed with this technology. The notion behind PIH occurrence is related to inflammation resulting from thermal damage by the CO2 laser. Over time, each agent used to decrease the incidence of PIH has received variable results. From this data, the use of ultra-potent TC appeared to reduce PIH, possibly by reducing postoperative inflammation. Antimicrobial therapies with antiinflammatory properties, such as topical fusidic acid, may also be beneficial in preventing PIH. Similarly, platelet-containing plasma appeared to reduce CO2 side effects, including PIH, when used in conjunction with CO2 laser treatment. The patient’s FSP did not appear to play a major role in the occurrence of PIH, as per the reporting studies. Further research is required to establish a clearer relation between skin type and PIH, and to examine preventative modalities to reduce PIH after CO2 laser treatment appropriately.
Funding Statement
Funding: none.
References
1. Conforti C, Vezzoni R, Giuffrida R, et al.. An overview on the role of CO2 laser in general dermatology. Dermatol Ther2021;34:e14692. [PubMed] [Google Scholar]
2. Kaplan I. The CO2 surgical laser. Photomed Laser Surg2010;28:847-8. [PubMed] [Google Scholar]
3. Cheyasak N, Manuskiatti W, Maneeprasopchoke P, Wanitphakdeedecha R.Topical corticosteroids minimise the risk of postinflammatory hyper-pigmentation after ablative fractional CO2 laser resurfacing in Asians. Acta Derm Venereol2015;95:201-5. [PubMed] [Google Scholar]
4. Kim J, Kim B, Kim S, et al.. The effect of human umbilical cord blood-derived mesenchymal stem cell media containing serum on recovery after laser treatment: a double-blinded, randomized, split-face controlled study. J Cosmet Dermatol2020;19:651-6. [PubMed] [Google Scholar]
5. Moon HR, Yun WJ, Lee YJ, et al.. A prospective, randomized, double- blind comparison of an ablative fractional 2940-nm erbiumdoped yttrium aluminum garnet laser with a nonablative fractional 1550-nm erbium-doped glass laser for the treatment of photoaged Asian skin. J Dermatolog Treat2015;26:551-7. [PubMed] [Google Scholar]
6. Rokhsar CK, Ciocon DH. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation after carbon dioxide laser resurfacing. Dermatol Surg2009;35:535-7. [PubMed] [Google Scholar]
7. Wat H, Wu DC, Chan HH. Fractional resurfacing in the Asian patient: current state of the art. Lasers Surg Med2017;49:45-59. [PubMed] [Google Scholar]
8. Kim JS, Ginter A, Ranjit-Reeves R, Woodward JA. Patient satisfaction and management of postoperative complications following ablative carbon dioxide laser resurfacing of the lower eyelids. Ophthalmic Plast Reconstr Surg2021;37:450-6. [PubMed] [Google Scholar]
9. Sarnoff D, Gotkin H, Doerfler B, et al.. The safety of laser skin resurfacing with the microablative carbon dioxide laser and review of the literature. J Drugs Dermatol2018;17:1157-62. [PubMed] [Google Scholar]
10. Bernstein LJ, Kauvar AN, Grossman MC, Geronemus RG. The short- and long-term side effects of carbon dioxide laser resurfacing. Dermatol Surg1997;23:519-25. [PubMed] [Google Scholar]
11. Gad SE, Neinaa YME, Rizk OK, Ghaly NER. Efficacy of plateletpoor plasma gel in combination with fractional CO(2) laser in striae distensae: a clinical, histological, and immunohistochemical study. J Cosmet Dermatol2021;20:3236-44. [PubMed] [Google Scholar]
12. Goh C. Management of post-acne scars in Asians-need for a paradigm shift? In: Australasian Journal of Dermatology. Wiley: Hoboken NJ USA; 2017. pp 57-57. [Google Scholar]
13. Jimenez JC, Montes JR, Maldonado J.Aesthetic benefits of CO2 laser photorejuvenation treatment for malar mounds (festoons). Invest Ophthalmol Visual Sci2015;56:4735. [Google Scholar]
14. Wei M, Li L, Zhang XF, et al.. Fusidic acid cream comparatively minimizes signs of inflammation and postinflammatory hyperpigmentation after ablative fractional CO2 laser resurfacing in Chinese patients: a randomized controlled trial. J Cosmet Dermatol2021;20:1692-9. [PubMed] [Google Scholar]
15. Techapichetvanich T, Wanitphakdeedecha R, Iamphonrat T, et al.. The effects of recombinant human epidermal growth factor containing ointment on wound healing and post inflammatory hyperpigmentation prevention after fractional ablative skin resurfacing: a split-face randomized controlled study. J Cosmet Dermatol2018;17:756-61. [PubMed] [Google Scholar]
16. Lueangarun S, Srituravanit A, Tempark T.Efficacy and safety of moisturizer containing 5% panthenol, madecassoside, and copperzinc- manganese versus 0.02% triamcinolone acetonide cream in decreasing adverse reaction and downtime after ablative fractional carbon dioxide laser resurfacing: A split-face, double-blinded, randomized, controlled trial. J Cosmet Dermatol2019;18:1751-7. [PubMed] [Google Scholar]
17. Neinaa YME, Gheida SF, Mohamed DAE. Synergistic effect of platelet-rich plasma in combination with fractional carbon dioxide laser versus its combination with pulsed dye laser in striae distensae: a comparative study. Photodermatol Photoimmunol Photomed2021;37:214-23. [PubMed] [Google Scholar]
18. Shin S, Shin JU, Lee Y, et al.. The effects of a multigrowth factorcontaining cream on recovery after laser treatment: a doubleblinded, randomized, split-face controlled study. J Cosmet Dermatol2017;16:76-83. [PubMed] [Google Scholar]
19. Lueangarun S, Tempark T.Efficacy of MAS063DP lotion vs 0.02% triamcinolone acetonide lotion in improving post-ablative fractional CO2 laser resurfacing wound healing: a split-face, triple-blinded, randomized, controlled trial. Int J Dermatol2018;57:480-7. [PubMed] [Google Scholar]
20. Alster TS, Nanni CA, Williams CM. Comparison of four carbon dioxide resurfacing lasers. A clinical and histopathologic evaluation. Dermatol Surg1999;25:153-9. [PubMed] [Google Scholar]
21. Al Mohizea S. The effect of menstrual cycle on laser induced hyperpigmentation. J Drugs Dermatol2013;12:1335-6. [PubMed] [Google Scholar]
22. Tan KL, Kurniawati C, Gold MH. Low risk of postinflammatory hyperpigmentation in skin types 4 and 5 after treatment with fractional CO2 laser device. J Drugs Dermatol2008;7:774-7. [PubMed] [Google Scholar]
23. Elmorsy EH, Elgarem YF, Sallam ES, Taha AAA. Fractional carbon dioxide laser versus carboxytherapy in treatment of striae distensae. Lasers Surg Med2021;53:1173-9. [PubMed] [Google Scholar]
24. Suh JH, Lee SK, et al.. Efficacy of bleomycin application on periungual warts after treatment with ablative carbon dioxide fractional laser: a pilot study. J Dermatolog Treat2020;31:410-4. [PubMed] [Google Scholar]
25. Al-Muriesh M, Huang CZ, Ye Z, Yang J.Dermoscopy and VISIA imager evaluations of non-insulated microneedle radiofrequency versus fractional CO2 laser treatments of striae distensae. J Eur Acad Dermatol Venereol2020;34:1859-66. [PubMed] [Google Scholar]
26. Wu PP, He H, Hong WD, et al.. The biological evaluation of fusidic acid and its hydrogenation derivative as antimicrobial and antiinflammatory agents. Infect Drug Resist2018;11:1945-57. [PMC free article] [PubMed] [Google Scholar]
27. Grimes PE. Management of hyperpigmentation in darker racial ethnic groups. Semin Cutan Med Surg2009;28:77-85. [PubMed] [Google Scholar]
28. Ruiz-Maldonado R, Orozco-Covarrubias ML. Postinflammatory hypopigmentation and hyperpigmentation. Semin Cutan Med Surg1997;16:36-43. [PubMed] [Google Scholar]
29. Sriprachya-anunt S, Marchell NL, Fitzpatrick RE, et al.. Facial resurfacing in patients with Fitzpatrick skin type IV. Lasers Surg Med2002;30:86-92. [PubMed] [Google Scholar]
30. West TB, Alster TS. Effect of pretreatment on the incidence of hyperpigmentation following cutaneous CO2 laser resurfacing. Dermatol Surg1999;25:15-17. [PubMed] [Google Scholar]
31. Takiwaki H, Shirai S, Kohno H, et al.. The degrees of UVBinduced erythema and pigmentation correlate linearly and are reduced in a parallel manner by topical anti-inflammatory agents. J Invest Dermatol1994;103:642-6. [PubMed] [Google Scholar]
32. Singh PK, Singh G.Relative potency of topical corticosteroid preparations. Indian J Dermatol Venereol Leprol1985;51:309-12. [PubMed] [Google Scholar]
33. Uaboonkul T, Nakakes A, Ayuthaya PK. A randomized control study of the prevention of hyperpigmentation post Q-switched Nd:YAG laser treatment of Hori nevus using topical fucidic acid plus betamethasone valerate cream versus fucidic acid cream. J Cosmet Laser Ther2012;14:145-9. [PubMed] [Google Scholar]
34. Doghaim NN, El-Tatawy RA, Neinaa YMEH. Assessment of the efficacy and safety of platelet poor plasma gel as autologous dermal filler for facial rejuvenation. J Cosmet Dermatol2019;18:1271-9. [PubMed] [Google Scholar]
35. Demidova-Rice TN, Hamblin MR, Herman IM. Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 2: role of growth factors in normal and pathological wound healing: therapeutic potential and methods of delivery. Adv Skin Wound Care2012;25:349. [PMC free article] [PubMed] [Google Scholar]
36. Saitta P, Krishnamurthy K, Brown LH. Bleomycin in dermatology: a review of intralesional applications. Dermatol Surg2008;34:1299-313. [PubMed] [Google Scholar]
37. Puder JJ, Blum CA, Mueller B, et al.. Menstrual cycle symptoms are associated with changes in low-grade inflammation. Eur J Clin Invest2006;36:58-64. [PubMed] [Google Scholar]
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