title: Dystrophic calcification and accentuated localized Argyria after fractionated carbon dioxide laser therapy of hypertrophic scars.
abstract: OBJECTIVE
  Fractionated, ultrapulsed carbon dioxide (CO2) laser therapy is a powerful tool for the treatment of scars. Common adverse effects of this therapeutic modality have been previously documented. We describe 2 unreported adverse effects of ultrapulsed CO2 laser treatment of mature scars in a patient previously treated with silver-impregnated dressings.
  
  
  METHODS
  A teenage survivor of toxic epidermal necrolysis presented with faint but diffuse dyschromia clinically and histologically consistent with localized argyria secondary to silver-impregnated dressings used years earlier. The patient was subsequently treated with fractionated CO2 for her scarring, but her hyperpigmentation worsened with each treatment. A subsequent biopsy specimen revealed a zone of dystrophic calcification with adjacent pseudo-ochronotic fibers that were not appreciated on biopsy specimens taken before CO2 laser treatment, suggesting unique complications not previously reported.
  
  
  CONCLUSIONS
  We present 2 unique complications secondary to ultrapulsed, fractionated CO2 laser treatment in a patient previously treated with silver-impregnated dressings: (1) the appearance of pseudo-ochronotic fibers in areas of worsening pigmentation and (2) evidence of dystrophic calcification limited to columns of fractionated laser ablation. Therefore, a history of argyria or treatment with silver-impregnated dressings should be considered before treatment with fractionated CO2 lasers.
authors.affiliation: University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Shaub
authors.affiliation: San Antonio Uniformed Services Health Education Consortium, Lackland Air Force Base, San Antonio, Texas.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Brown
authors.affiliation: San Antonio Uniformed Services Health Education Consortium, Lackland Air Force Base, San Antonio, Texas.
authors.forename: Todd T
authors.initials: TT
authors.lastname: Kobayashi
authors.affiliation: The Joint Pathology Center, Silver Spring, Maryland.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lewin-Smith
authors.affiliation: The Joint Pathology Center, Silver Spring, Maryland.
authors.forename: George P
authors.initials: GP
authors.lastname: Lupton
authors.affiliation: San Antonio Uniformed Services Health Education Consortium, Lackland Air Force Base, San Antonio, Texas.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Hivnor
mesh_terms: D000293:Adolescent; D001129:Argyria / Q000209:etiology* / Q000473:pathology; D001458:Bandages / Q000009:adverse effects; D001707:Biopsy, Needle; D002114:Calcinosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D017439:Cicatrix, Hypertrophic / Q000209:etiology / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D054020:Lasers, Gas / Q000009:adverse effects*; D028022:Low-Level Light Therapy / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D012834:Silver / Q000009:adverse effects; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D012834:Silver