Persistent Post-ablative Erythema After Carbon Dioxide Laser Resurfacing Producing a Pseudoatrophic Appearance:...

Persistent erythema following ablative carbon dioxide (CO₂) laser resurfacing is attributed to prolonged post-inflammatory vascular proliferation and may alter optical skin properties during the remodeling phase. We report a case of a 39-year-old woman who presented with diffuse erythema three months after CO₂ resurfacing for acne scars. The treated areas demonstrated a smooth, shiny appearance with reduced visibility of follicular ostia, raising concern for atrophic change. The patient underwent four sessions of 577-nm yellow laser therapy (FlexSys®; GME German Medical Engineering GmbH, Erlangen, Germany) at one-month intervals. Progressive reduction of erythema was observed, with significant improvement in vascular parameters on bilateral VISIA® analysis (Canfield Scientific, Inc., Parsippany, USA). As redness resolved, follicular ostia and baseline microrelief became more apparent. Decreased texture and pore percentiles were interpreted as enhanced visibility of the underlying skin's surface features rather than deterioration of the skin's quality. Findings suggest that persistent post-ablative erythema may transiently produce a pseudoatrophic appearance through vascular optical masking. Awareness of this phenomenon may prevent misinterpretation of early post-resurfacing outcomes.