Alabaster skin after carbon dioxide laser resurfacing with histologic correlation

Area of Science:

• Dermatology
• Aesthetic Medicine
• Pathology

Background:

• Carbon dioxide (CO2) laser resurfacing is a popular facial rejuvenation technique with a generally favorable safety profile.
• While initially associated with reversible side effects, delayed hypopigmentation has emerged as a recently reported complication.
• This condition manifests months post-procedure and is often permanent.

Observation:

• A case study detailing a patient who developed significant leukoderma (hypopigmentation) six months after full facial CO2 laser resurfacing.
• The patient underwent the procedure for widespread actinic keratoses.

Findings:

• Histologic examination of the postprocedure biopsy revealed dermal fibrosis.
• Immunohistochemical staining (MART-1) indicated no change in melanocyte count compared to preprocedure biopsy.
• Fontana-Mason staining demonstrated a significant decrease in epidermal melanin in the postprocedure biopsy.

Implications:

• This case provides clinical and histological evidence of delayed hypopigmentation following CO2 laser resurfacing.
• The findings suggest that the mechanism involves reduced epidermal melanin rather than melanocyte loss, mirroring observations in phenol chemical peels.
• This highlights the importance of recognizing and understanding this complication for improved patient counseling and management.