DAFTAR PUSTAKA

1. Fitzpatrick TB, et al. Fitzpatricks Dermatology In General Medicine, 7th edition. New
York : McGraw-Hill Companies; 2008. P:401-16.
2. Vachiramon V, Thadanipon K. Postinflammatory hypopigmentation. Clinical and
Experimental Dermatology 2011.
3. Larregue M, Martin J, Bressieux JM et al. Vitiligoid achromias and severe atopic
dermatitis. Apropos of 4 cases. Ann Dermatol Venereol 1985; 112: 589600.
4. Ruiz-Maldonado R, Orozco-Covarrubias ML. Postinflammatory hypopigmentation and
hyperpigmentation. Semin Cutan Med Surg 1997; 16: 3643.
5. Savant SS. Facial dermabrasion in acne scars and genodermatoses a study of 65
patients. Indian J Dermatol Venereol Leprol 2000; 66: 7984.
6. Grimes PE, Bhawan J, Kim J et al. Laser resurfacinginduced hypopigmentation:
histologic alterations and repigmentation with topical photochemotherapy. Dermatol
Surg 2001; 27: 51520.
7. Verma S, Patterson JW, Derdeyn AS et al. Hypopigmented macules in an Indian man.
Arch Dermatol 2006; 142:16438.
8. Rowley MJ, Nesbitt LT Jr, Carrington PR, Espinoza CG. Hypopigmented macules in
acantholytic disorders. Int J Dermatol 1995; 34: 3902.
9. Xiang W, Xu A, Xu J et al. In vivo confocal laser scanning microscopy of
hypopigmented macules: a preliminary comparison of confocal images in vitiligo, nevus
depigmentosus and postinflammatory hypopigmentation. Lasers Med Sci 2010; 25: 551
8.
10. High WA, Pandya AG. Pilot trial of 1% pimecrolimus cream in the treatment of
seborrheic dermatitis in African American adults with associated hypopigmentation. J
Am Acad Dermatol 2006; 54: 10838.
11. Tierney EP, Hanke CW. Treatment of CO2 laser induced hypopigmentation with ablative
fractionated laser resurfacing: case report and review of the literature. J Drugs Dermatol
2010; 9: 14206.

Hypopigmented macules in an Indian man.

Verma S, Patterson JW, Derdeyn AS, Pasale R, Patel D, Ganju A.

Author information

University of Virginia, Charlottesville, USA.

PMID:
17178995
[PubMed - indexed for MEDLINE]

Ann Dermatol Venereol. 1985;112(8):589-600.

[Vitiligoid achromias and severe atopic

dermatitis. Apropos of 4 cases].
[Article in French]
Larrgue M, Martin J, Bressieux JM, Canuel C, De Giacomoni P, Ramdene P, Babin P.

Abstract
Four patients with important and disabling atopic dermatitis persisting during adulthood have
presented leucodermia in certain areas of eczema. As melanosomes and melanocytes have
totally disappeared in these regions, this depigmentation corresponds thus to an achromia.
Clinically, we noted macular achromia with hyperpigmented border of special topography
since touching pleat regions initially present eczema lesions: anterior face of wrists and
footnecks. Slight lichenification is noted in achromic regions. In spite of many analogies with
vitiligo, we differentiate this achromia from vitiligo on the basis of absence of familial posthistory and absence of new localisations after 5 to 6 years cause. A review of depigmentations
described during atopic dermatitis does not show similar facts. Depigmentation induced by
local steroid therapy does not give such clinical and ultrastructural aspects. In 3 patients,
there was no local application of depigmenting agent. In one case, 8-oxyquinoleine was
applied transiently. Vitiliginous achromias of pleat regions initially presenting important
atopic dermatitis are probably due to multifactorial factors: possible factors are inflammation
and secondary epidermal modification due to local steroid therapy and may be some
excipients. Being a rare situation in atopy, we have registered it only 14 times in 860
followed atopic dermatitis. The study of series of atopic dermatitis followed on a long-term
basis should allow to evaluate the frequency of such incidents and the respective role of
aetiological factors with we suspect.
PMID:

4096464
[PubMed - indexed for MEDLINE]

Facial dermabrasion in acne scars and

genodermatoses-A study of 65 patients
SS Savant

Abstract
bermabrasion is sequential planing of the raised skin/lesions to the desired depth. Facial
dermabrasion was carried out in 65 patients (acne scars -48, adenoma sebaceum 12, multiple
trichoepitheliomas 4, barier's diease-1). Preancillary acne scar revision in 34/48 patients and
excision of larger papules and electrodesiccation was performed in 10/12 adenoma sebaceum.
In acne scars, 35/48 showed good to excellent and 13/48 poor results. In adenoma sebaceum,
9/12 had excellent and 3 satisfactory results. Preancillary procedures enhanced results in both
conditions. Excellent results were obtained in 3/4 multiple trichoepitheliomas and in barier's
disease. Repeat dermabrasion was helpful in 7/65 patients. Side effects seen were persistent
hypopigmentation 41, persistent erythema 30, milia 20, hyperpigmentation 15 and
exacerbation of acne 3. Complications encountered were small deep scars 8, recurrence of
adenoma sebaceum 3, gouging 2, secondary infection 2, oval large atrophic hypodepigmented scar I and hypertrophic linear scar 1. Facial dermabrasion is a useful
dermatosurgical modality to treat various skin disorders.

Keywords: Dermabrasion, Acne scars, Trichoepitheliomas, Adenoma sebaceum, Dariers

disease
How to cite this article:
Savant S S. Facial dermabrasion in acne scars and genodermatoses-A study of 65 patients.
Indian J Dermatol Venereol Leprol 2000;66:79-84
How to cite this URL:
Savant S S. Facial dermabrasion in acne scars and genodermatoses-A study of 65 patients.
Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2014 Jan 28];66:79-84.
Available from: http://www.ijdvl.com/text.asp?2000/66/2/79/4875

Introduction
Dermabrasion (DA) consists of sequential planing of the raised skin/lesions with electrical
and/ or manual abraders and allowing the wound to heal by secondary intention, so as to
achieve a levelling effect to make the lesions less conspicuous. [1],[2] Facial DA carried out on

entire face is primarily utilised for its cosmetic as well as therapeutic value in treating
exophytic genodermatoses or various facial skin tumours such as adenoma sebaceum,
multiple trichoepitheliomas, Darier's disease, multiple neurofibromatosis, syringomas etc. [1],
[2],[3],[4],[5]
In this study, facial DA performed in 65 patients for various conditions such as acne
scars, adenoma sebaceum, multiple trichoepitheliomas and Darier's disease is reported
herewith.
Materials and Methods
Sixty-five patients (45 females and 20 males, age range 16-54) participated in this study.
Facial DA was carried out in -acne scars 48, adenoma sebaceum 12, multiple
trichoepitheliomas 4, and Darier's disease 1. The acne scars varied in shape from circular,
oval, linear to irregular and had depressed bases. They were either shallow or deep, varied in
size from 2 to 50mm and ranged in number from 30 to 70. Nineteen patients gave a history of
sporadic activity. These were first treated with broad spectrum antibiotic and local exfoliating
agents and then subjected to DA. Prior acne scar revision (ASR) was carried out in 34/48
patients in one or more sittings, 6-8 weeks prior to DA. These were subcision followed by
cryoslush punch excision and suturing, punch incision and elevation, punch excision and
graft replacement and elliptical excision and suturing. The other 14 patients were taken up
directly for DA because they had scars covering more than 70% of the face. Small to medium
sized papular lesions in 10/12 cases of adenoma sebaceum were electrodesiccated and large
lesions were excised 6-8 weeks prior to DA. Four cases of multiple trichoepitheliomas, two
cases of adenoma sebaceum and single case of Darier's disease were taken up directly for
DA.
Haemogram, blood sugar, BT, CT, PT, routine urinalysis, X-ray chest, ECG and screening for
syphilis (VDRL), HIV and hepatitis B were done for all patients. Biopsy was performed to
confirm all genetic disorders. BCG scars or old scars were examined for keloidal tendency
and written consent was obtained along with fitness for general anaesthesia (GA).
Main instruments used were manual metallic dermabraders, motor driven wire brushes or
diamond fraises mounted on electric hand machine and number 80 and 110 sand (water)
papers. After surgical preparation and isolation, 60 patients were given GA of IV ketamine
hydrochloride combined with local tumescent anaesthesia consisting of 1 litre of normal
saline, 50 ml of 1% xylocaine, 1 ml of 1: 1000 adrenaline and 12.5 ml of sodabicarbonate 1
m eq. The other 5 patients were given GA of halothane after napentothal induction and
intubation combined with local tumescent anaesthesia. In acne scar cases, first the marked
scars were individually smoothened out by abrading their bases and edges.Submandibular
margin was established in all cases by dermabrading along the marked line from ear to the
chin on both sides. The infraorbital margin was then established by dermabrading downwards
on to the cheeks and sideways on to the temporal regions leaving 2-3 cm of the skin around
the eyes unabraded. Initially the face was abraded superficially to get rid of epidermis and
reach the superficial papillary dermis. Further deep DA was carried out in the following order
of cosmetic units-right cheek, chin, left cheek, forehead, glabella, nose and upper lip till the
junction of deep papillary and upper reticular dermis. In patients of adenoma sebaceum,
multiple trichoepitheliomas and Darier's disease, all the raised lesions were flattened with
proper contouring. DA was then continued with manual metallic dermabraders, till the
junction of upper and mid reticular dermis. Important landmarks corresponding to the level of

depth in the skin were standardised while dermabrading and were as follows:
1. Loss of skin pigment-epidermis
2. Multiple tiny punctate bleeding points-Superficial papillary dermis.
3. Change in bleeding pattern with appearance of larger rapidly bleeding points with low field
densityJunction of mid to deep papillary dermis.
4. Whitish pink parallel ridges - Junction of upper and mid reticular dermis.
5. Break in these ridges with fraying - Junction of upper and mid reticular dermis. (Optimum
depth and termination point).
Finally two rubs were given with no. 80 followed by no. 110 water papers to smoothen out
the surface. Haemostasis was achieved by pressure and the wounds were covered with double
layer of framycetin tulle. All patients were given broad specrum antibiotic, anti-inflammatory
drugs and analgesics for the first few days. Tapering doses of steroids were used IV or orally
(1-4mg of dexamethasone) for first 3-4 days. There was considerable oedema, pain and
serous discharge in the first 48-72 hours. Gradually the discharge reduced and the tulle
adhered to the underlying wound surface. It came off completely by 10th - 15th day. Patients
remained hospitalised for first 10-15 days and were further sun protected by avoiding direct
sunlight or by using umbrella, sun screening agents with SPF of 15 and above and emollients
for next 23 months. All 65 patients were followed up for 6 months, 52 for one year, and16 for
3 years.
Results
In all patients abraded area healed with erythema, hypopigmentation and demarcation at the
submandibular margin which reduced over next 312 months. Out of the 48 patients of acne
scars the cosmetic result was excellent (>60% improvement) in 15, good (35-60%
improvement) in 20, and poor (<35% improvement) in 13. Repeat DA after 12-15 months in
3 of them yielded excellent result. Of the 34 patients who underwent ASR prior to DA, results
were excellent in 15, good in 16 and poor in 3. Out of the remaining 14 patients who were
directly dermabraded 4 had good result and 10 poor. Of the 19 patients who complained of
sporadic activity of acne, 12 showed more than 50% reduction in their activity. Excellent
results were obtained in 9/12 patients of adenoma sebaceum, whose lesions were
preancillarily treated with electrodesiccation and surgical excision. The remaining 3 patients
(2 directly dermabraded) showed recurrence and repeat dermabrasion after 9-15 months, gave
excellent cosmetic results. Excellent cosmetic results were achieved in 3/4 patients of
multiple trichoepitheliomas. In one patient with massive nodules repeat DA after 6 months
yielded improved cosmetic results. The single patient of Darier's disease healed very well
with smooth uniformity pigmented skin surface.
Side effects seen were persistent hypopigmentation 41, persistent erythema 30, milia 20,
hyperpigmentation 15 and exacerbation of acne 3 patients. Complications encountered were
small deep pitted scars 8, recurrence of adenoma sebaceum 3, gouging 2 and localised
secondary infection 2 patients (3 sites). Of this, one site responded well to higher antibiotic

whereas other two sites healed with scarring (linear hypertrophic 0.5cm X 2.5 cm and oval
atrophic 1.5 cm diam).
Discussion
Acne vulgaris depending on its severity, can end with a variety of scars. Many treatment
modalities for scar improvement such as cryoslush with carbon dioxide snow, liquid nitrogen
cryopeel, surgical scar revision, electrosurgical planing, chemical peeling, filler substance
implantation, iontophoresis, DA, laser abrasion, etc have been developed. [6],[7] The affected
skin of post acne scarring has an abnormal contour with most scars being depressed below
the adjacent normal skin. DA is primarily performed on the surrounding normal skin for the
levelling effect. [1],[2] There is regeneration of the collagen tissue during the wound healing
process. This further remodels and undergoes contraction during maturation process causing
flattening effect, thus improving the overall appearance of the acne scars. [1],[2] DA carried to
optimum depth appears to be the key solution for the improvement of acne scars. It does not
significantly improve scars with wide atrophic base, punched out deep scars and ice pick
scars. [1],[2],[3],[4],[5],[6],[7] Aronsonn et all in their study of 25 cases observed that 50% improved
with DA and concluded that those with small and superficial scars showed better results than
those with deep scars. In the present study also it was noted that the superficial scars
disappeared completely whereas deep pitted ice pick or irregular scars did not improve unless
they had been revised before DA. Various ASR procedures tailored to improve individual
scars have been described in literature. [2],[3],[4],[5],[6],[7] They were carried out in 31/34 patients
with good to excellent results 6-8 weeks before DA.
In acne scars, 37.5% had 60% or more improvement; 41.7% had 35-60% and 20.8% had less
than 35% improvement. The improvement obtained in this series is less than those attained
by Alt et al. [2] They have achieved overall improvement of 60% to 70% in more than 75% of
the patients. The higher improvement obtained could be due to difference in the techniques
followed. In this study, patients were dermabraded using combination of general and local
tumescent anaesthesia whereas Alt et al, [2] Roenigk [3] and Yarborough et al have all used
cryoanaesthesia (freon + ethyl chloride mixture - fluro ethyl). Alt et al have pointed out that
when the skin is frozen during cryoanaesthesia it is firm, nonpliable, nonmobile and hence
can be abraded easily. Cryoanaesthesia also causes haemostasis and the landmarks like
capillary loops, yellow sebaceous glands etc can be easily visualised, and thus DA can be
effectively carried out to the optimal desired depth. Despite all these advantages,
cryoanaesthesia was not used in this study as it is not available in India. Alt et al have stated
that manual stretching of the skin during DA should be avoided as stretching will flatten out
the scars. Marking of the acne scars prior to anaesthesia helped in better visualisation and
easy abrasion. The advantage of tumification and manual stretching was that the skin surface
remained firm and the dermabraders could be moved freely. Tumescence also safeguards the
underlying important tissues from injury [1],[2] and has haemostatic effect due to its physical
pressure and the adrenaline added to it. Maneksha has achieved excellent results in small pox
and acne scars with manual metallic dermabraders and sandpapers. [10] In this study initial DA
was carried out electrically with hand motor till the junction of deep papillary and upper
reticular dermis and further deep DA was done manually with metallic dermabraders and
sandpapers. This way the procedure was faster and provided safety to deeper and surrounding
structures. Many workers advocate repeat DA rather than a single aggressive DA to achieve
better cosmetic result and avoid complications. [1],[2] The same was confirmed in 3 patients

with severe acne scarring in this study. It has been observed that DA is effective in improving
chronic active acne, [1],[2],[3] which was confirmed in this study as 12/19 sporadically active
patients of acne showed reduction in their activity. Exact mechanism of this therapeutic
benefit of DA is not known but may be due to drainage and deroofing of comedones and
cysts or its direct effect on the pilosebaceous apparatus. [1],[2]
Facial lesions of adenoma sebaceum pose a problem of cosmesis and consist of multiple
angiofibromas of various sizes. Treatment has included excision, DA, cryosurgery, lasers etc.
[1],[2],[3],[4]
Alt et all have recommended DA alone. Verheyden [4] found excellent results
combining shave excision with DA in 3 patients. Kaufman et al [11] who have treated 9
patients with copper vapour laser, found that 50% of them had recurrence needing further
treatment. In this study combining electrodesiccation for small lesions and surgical excision
for large lesions with DA after a gap of 6-8 weeks was found to give good cosmetic results in
9 patients. Remaining 3 patients had to be dermabraded again for recurrence, thus confirming
that combining two methods can be advantageous in providing excellent cosmetic result and
avoiding or reducing recurrence.
Multiple trichoepitheliomas are benign neoplasms of the hair follicles and present as fleshcoloured round papules and nodules with centrofacial distribution. [12] Multiple methods of
treatment including surgical excision, DA, cryosurgery and laser surgery have been reported
in literature to treat this cosmetic problem. [3],[4],[5],[6],[7],[8],[9],[10],[11],[12] In this study DA was
carried out on 4 cases with excellent results. Roenigk [3] has reported impressive results in 3
patients by using wire brush. He has further reported regrowth of tumours on follow up in 1
patient but with less severity. In this study too, wire brush followed by manual DA was used
to plane away hundreds of lesions and the wounds healed with smooth flattened skin surface
without scarring thus providing a very high cosmetic relief with safety to the patients.
In Darier's disease medical modalities of treatment have only temporary success. [13]
Hyperkeratotic localised lesions have been treated by surgical excision and grafting,
cryosurgery, laser abrasion or DA. [14] Surgical modality of full face DA has been indicated for
facial lesions, [1],[2],[3] and this was confirmed in this study.
Most common side effect seen was persistent hypopigmentation which although gradually
reduced in 3-9 months, persisted permanently in 41 patients. During DA, facial skin along
with its melanocytes is lost suddently. This couples with sun restriction measures contribute
towards early and prolonged hypopigmentation. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] Erythema
was another side effect which persisted and then improved completely over a period of 3-6
months in 30 patients. Post operative erythema represents angiogenesis and occurs during
wond healing in all the patients. It persists for longer time where DA has been carried to
greater depth. [2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] as was seen in this study. Hyperpigmentation
was observed in 15 patients which reverted completely to normal on treatment with
hydroquinone creams and sunscreens in 3-6 months. It is a known phenomenon that skin
trauma or many inflammatory skin diseases induce post-inflammatory hyperpigmentation [16]
in Fitzpatrick skin type IV,V and VI and hence it is recommended that resurfacing should be
done with caution. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] Milia formation (20) and flare up of
acne (3) occurred 1-4 months after the surgery. These have been described as postoperative
sequelae due to the occlusion effect to the petrolatum based ointments and sunscreen agents
used postoperatively. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15]
DA when carried into deep reticular dermis can lead to scarring. [1],[2] This was seen in 8

patients of acne scars and can be avoided by accurate planing. Recurrence of adenoma
sebaceum was noted in 3/12 patients. The lesions of any exophytic condition such as multiple
trichoepitheliomas, multiple neurofibromatosis, adenoma sebaceum etc. are situated deep in
dermis and hence liable for regrowth if partially removed. [3],[4] Also being genetic disorders
new lesions can always crop up at a later date. [11] However, pre-ancillary procedures can help
minimise recurrence as was seen in this study. In 2 patients of acne scars gouging occurred
because the lax skin got caught in the wire brush as it was not properly stretched, thus
bringing out the importance of stretching during DA. [1] Secondary bacterial infection as a
result of improper compliance on part of patients was seen in 2 patients (3 sites) and led to
scarring at 2 sites in one patient. Of these one remained permanent (oval atrophic) and the
other (linear hypertrophic) showed considerable improvement on treatment with intralesional
steroid injection and silastic gel sheet dressing.
Facial DA, in this study, was found to be very useful for acne scars and exophytic
genodermatoses such as adenoma sebaceum, multiple trechoepitheliomas and Darier's
disease, thus bringing out the importance of it being an excellent modality for both cosmetic
and therapeutic application. This study also brings out the usefulness of preancillary
treatment before final resurfacing in acne scars and adenoma sebaceum and the importance of
repeat DA to further improve cosmesis, treat recurrences and avoid complications of single
aggressive DA. various technical adaptations adjustable to the Indian scenario were followed
in this study. [1] Combination anaesthesia (IV ketamine and local tumescent) used to nonavailability of surface cryoanaesthetic agents in India, was found to be safe, was easily
available, economical and achieved desired optimal anaesthetic effects. The local tumescent
was useful in making the skin taut and for achieving better haemostasis. This helped in proper
visualization of various landmarks and DA could be carried out to the desired optimum depth.
Various landmarks were standardised in this study, corresponding to the related level of depth
in the skin. This is the most important finding of this study. Another useful adaptation
followed in this study was the combined technique of using electrical and manual DA. This
cuts down the total time required for the procedure and makes it safe. All these adaptations,
help in minimising side effects, complications and achieve good therapeutic and cosmetic
results.
Other modalities useful for facial skin resurfacing apart from DA are chemical peeling [17] and
lasers. [18],[19] However DA is found to be superior to peeling in removing acne scars. [17] Also
exophytic growths cannot be treated by peeling. [17] Lasers are easy to operate and achieve
precise desired depth through micrometer accuracy. [18] Carbon-dioxide laser causes
haemostasis and immediate skin tightening through collagen contraction. [18] However it can
cause pigmentary problems in skin type V [18],[19],[20] Erbium Yag laser is suitable for darker
skin type but it cannot reach the optimum depth to correct acne scars. [19] Also the cost of
lasers is as yet prohibitive and no long term studies have standardised the technique on Indian
skin types. Dermabrasion thus still remains the only major effective, inexpensive cosmetic as
well as therapeutic skin resurfacing modality available in India for successfully treating a vast
variety of skin conditions. Although the procedure is complex, once mastered, the results are
gratifying for both the patient and surgeon. However proper patient selection, technical
perfection and good postoperative management are the keys to its success.

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Int J Dermatol. 1995 Jun;34(6):390-2.

Hypopigmented macules in acantholytic disorders.
Rowley MJ, Nesbitt LT Jr, Carrington PR, Espinoza CG.
Author information
Abstract
BACKGROUND:

Widespread hypopigmented macules are rarely seen in heavily pigmented patients with
Darier's disease. Previous hypotheses concerning the cause of decreased pigmentation
suggest it is a postinflammatory phenomenon or that the hypomelanosis is evidence of
subclinical acantholysis.
PATIENTS:

This report presents 2 patients: a new case of disseminated guttate leukoderma in a black
patient with Darier's disease and the first such case in a patient with transient acantholytic
dermatosis (Grover's disease). Direct immunofluorescence and electron-microscopic studies
were carried out on lesional biopsies.
OBSERVATIONS:

Numerous small hypopigmented macules were observed in two black patients followed for
acantholytic disorders. Three biopsies of the hypopigmented macules revealed acantholysis,
while one showed only decreased melanin. Direct immunofluorescence studies were
negative. Electron-microscopic studies of the leukodermic macules showed sparse
melanocytes and melanosomes that were mostly pigmented stage IV melanosomes.
CONCLUSIONS:

Disseminated guttate leukoderma can occur in transient acantholytic dermatosis, as well as in

Darier's disease. It is readily apparent on darkly pigmented skin because of contrast. The
etiology of this phenomenon is still unknown.
PMID:
7657436
[PubMed - indexed for MEDLINE]

J Am Acad Dermatol. 2006 Jun;54(6):1083-8.

Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in

African American adults with associated hypopigmentation.
High WA, Pandya AG.
Author information
Abstract
BACKGROUND:

African Americans with seborrheic dermatitis may manifest associated hypopigmenation.

Corticosteroids and antifungals are often used for treatment, yet chronic use of corticosteroids
may be associated with skin atrophy, increased intraocular pressure, or further
hypopigmenation. Pimecrolimus has been used successfully in a few patients with seborrheic
dermatitis.
OBJECTIVES:

This open-label, pilot trial assessed the efficacy and tolerability of pimecrolimus in the
treatment of seborrheic dermatitis in African Americans with hypopigmentation.
METHODS:

Five African American adults with seborrheic dermatitis used a thin layer of pimecrolimus on
the involved areas twice per day for 16 weeks. Clinical measures of improvement included
erythema, scaling, and pruritus. Hypopigmentation was measured objectively using a
mexameter.
RESULTS:

All participants noted a marked decrease in the severity of their condition. An improvement
in hypopigmentation was also noted. For all indicators, the magnitude of improvement was
most marked during the initial 2 weeks of treatment.
LIMITATIONS:

This was an open-label pilot trial limited to just 6 participants, only 5 of whom completed the
study.
CONCLUSIONS:

Topical pimecrolimus cream may be an excellent alternative therapeutic modality for treating
seborrheic dermatitis in African Americans, particularly in those with associated
hypopigmentation.
PMID:
16713477
[PubMed - indexed for MEDLINE]
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Treatment of CO2 laser induced hypopigmentation with ablative fractionated

laser resurfacing: case report and review of the literature.
Tierney EP, Hanke CW.
Author information
Abstract
BACKGROUND:

The carbon dioxide laser (CO2) has been proven to be an effective device for the treatment of
photoaging. However, it is associated with adverse side effects including prolonged erythema,
edema, burning, milia, acne, crusting and hypo-/hyperpigmentation. Delayed onset
hypopigmentation after CO, laser resurfacing can markedly detract from clinical outcomes.
To overcome the disadvantages of traditional ablative and non-ablative resurfacing, fractional
photothermolysis (FP) has been introduced. FP has been demonstrated in early case reports
and case series to produce significant improvement in hypopigmentation of acne and surgical
scars.
CASE REPORT:

A 53-year-old Caucasian female with Fitzpatrick type I skin presented with a nine-month
history of delayed onset hypopigmentation following ablative CO2 laser resurfacing. After a
series of three treatments at eight-week intervals with an ablative fractionated CO2 laser
device, the hypopigmentation and line of pigmentary demarcation between the face and neck
improved by 75 percent.
CONCLUSION:

Ablative fractional resurfacing is a safe and potentially effective modality for the treatment of
CO2 laser induced hypopigmentation on the face.