Increased rates of laser-induced scarring call for dermatologists’ expertise
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Key takeaways:
- Inexperienced practitioners and a growing aesthetic demand have increased laser complications.
- Laser assisted delivery of bimatoprost achieves the best results in laser-induced hypopigmentation treatment.
Dermatologists are needed to remedy the increasing incidence of laser complications and educate patients on the risks involved with laser treatment, according to a speaker at the Pigmentary Disorders Exchange Symposium.
“Right now, we are seeing massive laser-complications, more than I’ve ever seen in my career,” Jill S. Waibel, MD, subsection chief of dermatology at Baptist Hospital of Miami and medical director of Miami Cancer Institute’s Multidisciplinary Skin Cancer Clinic, told Healio.
“Patients have even committed suicide because they've been disfigured,” Waibel continued, emphasizing the severe repercussions of laser malpractice.
While these complications are mainly inflicted by inexperienced providers, dermatologists are now in the position where they must remedy these complications and educate their patients on how to avoid permanent laser-inflicted scarring — especially hypopigmented scarring.
According to Waibel, the influx of these complications may be due to the fact that many practitioners are not adhering to the laws surrounding energy-based devices. Additionally, the aesthetic field is booming, which has resulted in patients trusting non-dermatologists and non-plastic surgeons with complicated procedures.
Dermatologists have been left to pick up the pieces; however, the literature surrounding the reversal of laser-induced hypopigmentation is sparse. As a result, Waibel and her colleagues conducted a study evaluating possible ways to stimulate pigment in cosmetic and medical hypopigmentation conditions.
Results showed that the best technique was laser assisted delivery of bimatoprost. Bimatoprost is a growth hormone used to treat glaucoma that exhibits a hyperpigmentation side effect due to increased melanogenesis.
In her practice, Waibel uses the ablative laser at a shallow depth of 75 µm followed by topical bimatoprost twice daily for a week.
Waibel noted that this technique has achieved the best results, especially in patients with skin of color as they tend to repigment best.
While laser assisted delivery of bimatoprost showed the best outcomes, other methods may be more effective for other patients such as a simple use of the 1,550 nm non-ablative laser or melanocyte transfers.
As laser-induced scarring continues to be a problem, there is a growing need for dermatologists to not only treat these scars, but also educate patients on how to prevent them, according to Waibel.
“There’s so much marketing going on that patients don’t have a sense of safety, and once they have it happen to them, it’s sad,” Waibel said. “Dermatologists really have to educate patient consumers on where to go.”
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Waibel JS, et al. When the solution becomes the problem: Laser-induced hypopigmentation. Presented at: Pigmentary Disorders Exchange Symposium; May 5-6, 2023; Chicago.
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