Alabaster skin after carbon dioxide laser resurfacing with histologic correlation.
BACKGROUND
Carbon dioxide laser resurfacing has gained popularity as a relatively safe and effective method of facial rejuvenation. Original reports describe mostly reversible side effects and a low incidence of scarring. Only very recently have reports of delayed hypopigmentation surfaced. This effect is not visible until several months after resurfacing, and most likely represents a permanent change.


OBJECTIVE
To provide an additional clinical description of the complication of delayed hypopigmentation along with the first published histologic correlation.


METHODS
Clinical records along with a preprocedure and 7-month postprocedure full-thickness skin biopsy were used for this report.


RESULTS
This patient experienced a striking leukoderma 6 months after a full facial carbon dioxide laser resurfacing procedure done for widespread actinic keratoses. There was a zone of dermal fibrosis extending approximately 0.4 mm on the postprocedure biopsy. Comparison of the preprocedure and postprocedure biopsies revealed no difference in the number of melanocytes by MART-1 immunohistochemical staining, but there was a significant decrease in epidermal melanin as determined by Fontana-Mason staining.


CONCLUSIONS
This patient experienced a profound expression of an increasingly recognized and reported complication of carbon dioxide laser resurfacing. Histologic correlation is similar to the results previously reported after phenol chemical peels, demonstrating a normal number of melanocytes but a decrease in epidermal melanin.
Laws
R A
RA
Department of Dermatology, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200, USA.
Finley
E M
EM
McCollough
M L
ML
Grabski
W J
WJ
D002245:Carbon Dioxide; D005260:Female; D006801:Humans; D017496:Hypopigmentation / Q000209:etiology* / Q000473:pathology*; D007642:Keratosis / Q000601:surgery*; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged
D002245:Carbon Dioxide