CO2 Laser Use Tied to Complications in Scar Patient

January 14, 2014

By David Douglas

NEW YORK (Reuters Health) Jan 14 - Ultrapulsed, fractionated CO2 laser therapy for hypertrophic scars in a patient previously treated with silver-impregnated dressings led to worsening pigmentation and dystrophic calcification, U.S. doctors warn.

Dr. Amanda R. Shaub told Reuters Health by email that given the complications her team saw in this patient, "We suggest that a history of argyria or silver-impregnated dressing use be considered before treatment of hypertrophic scarring with the fractionated, ultrapulsed CO2 laser."

In a January 8 online report in JAMA Dermatology, Dr. Shaub of the University of Chicago Medical Center and colleagues note that "most of the literature on the adverse events associated with fractionated CO2 laser therapy has focused on patients receiving cosmetic resurfacing and rejuvenation rather than treatment for hypertrophic scars."

One study in patients with hypertrophic scars, published in 2013 in the Annals of Plastic Surgery, found adverse events to be exceedingly rare. Postoperative pain was the most common and no cases of hyperpigmentation were seen among patients treated with the CO2 laser.

The patient in the current study, a teenage girl who survived toxic epidermal necrolysis with nearly complete body surface area involvement eight years earlier, had not improved with previous pulsed dye laser treatments.

There was faint but diffuse dyschromia and biopsy showed scattered black granules intermixed throughout the dermal scar. The resulting pigmentation was probably due to earlier use of silver-impregnated dressings, the researchers note.

The patient's hyperpigmentation worsened with each CO2 laser treatment. Moreover, say the investigators, a subsequent biopsy specimen revealed a zone of dystrophic calcification with adjacent pseudo-ochronotic fibers. The zone was "spaced at regular intervals and at approximately the same dermal depth suggestive of dystrophic calcification in the wake of fractionated ablative laser."

They go on to point out, "To our knowledge, neither dystrophic calcification nor worsening of cutaneous pigmentation in conjunction with the appearance of pseudo-ochronotic fibers has been reported after ablative fractional resurfacing."

"Of course, further research needs to be conducted to determine the mechanism through which these complications occurred," added Dr. Shaub.

Meanwhile, she and her colleagues suggest that "a history of argyria or treatment with silver-impregnated dressings should be considered before treatment with fractionated CO2 lasers."

In addition, they conclude, "Continual surveillance for traumatic calcification should also be considered because fractionated treatments for burn scars continue to gain popularity."


JAMA Dermatol 2014.


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