Effect of pretreatment on the incidence of hyperpigmentation following cutaneous CO2 laser resurfacing

BACKGROUND. Transient hyperpigmentation is the most common complication seen following cutaneous carbon dioxide (CO2) laser resurfacing. OBJECTIVE. The purpose of this study was to determine whether the use of a topical skin lightening regimen prior to cutaneous laser resurfacing reduces the incidence of post-laser resurfacing hyperpigmentation. METHODS. One hundred consecutive CO2 laser resurfacing patients (skin types I-III) were randomized to receive preoperative treatment with 10% glycolic acid cream twice daily (n = 25), hydroquinone 4% cream qHS and tretinoin 0.025% cream twice daily (n = 25) or no pretreatment (n = 50, control) for at least 2 weeks. Clinical and photographic assessments were performed prior to laser resurfacing and at 4 and 12 weeks following treatment. RESULTS. There was no significant difference in the incidence of post-CO2 laser resurfacing hyperpigmentation between subjects who received pretreatment with either topical glycolic acid cream or combination tretinoin/hydroquinone creams and those who received no pretreatment regimen. CONCLUSION. It is postulated that reepithelialization after cutaneous laser resurfacing includes follicular melanocytes that have not been affected by topical pretreatment. When instituted as a component of the skin care regimen postoperatively, topical hydroquinone, tretinoin and/or glycolic acid preparations may be helpful in reducing post-laser resurfacing hyperpigmentation.