What is included in the dermatologic preoperative evaluation and management of skin resurfacing?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Skin resurfacing can be accomplished via dermabrasion, chemical peeling, or ablative lasers. [26] Commonly used for scar revisions and treatment of aging skin, these procedures have several adverse effects, such as milia, erythema, pigment changes, and increased sun sensitivity. A test spot may be recommended to assess response and healing in advance of the procedure.

An increased risk of scarring exists, especially with bacterial or viral infection. If a patient has a history of frequent herpes eruptions, the patient should be treated prophylactically. Herpes simplex virus may disseminate on the denuded skin of a dermabraded site during the healing phase. Acyclovir has been used as a treatment, as well as to prevent this occurrence in patients with a history of recurrent herpes simplex. Acyclovir is given 1-2 days prior to dermabrasion or laser skin ablation, and the prophylactic treatment should be continued during the time of healing.

Skin refrigerants are used in dermabrasion for anesthesia and hemostasis and to establish a firm surface. Cryopathies and diseases associated with cryopathy should be investigated in the medical history. Some physicians may test for cryoglobulin and cryofibrinogen levels prior to dermabrasion. Additionally, some of the refrigerants have been associated with increased scarring.

Isotretinoin has been associated with unusual postoperative scarring after dermabrasion, despite intervals as long as 6-14 months between discontinuation of the drug and the dermabrasion.


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