Laser skin resurfacing. Pre- and posttreatment guidelines.

BACKGROUND: Carbon dioxide laser skin resurfacing using either ultrapulsed lasers or scanning skin lasers has evolved as an effective method of treating photodamaged skin.
OBJECTIVE: The purpose of this paper is to describe appropriate pre- and posttreatment regimens to ensure the optimum response to laser therapy.
METHODS: We describe our experiences with 30 patients treated with laser skin resurfacing using different pre- and posttreatment regimens. Patients were evaluated by physicians as regards to their responses to and recovery from laser therapy. Some patients agreed to skin biopsy and cutaneous patch testing of topically applied agents.
RESULTS: Eighty percent of patients achieved good to excellent improvement. Sixty-five percent of patients undergoing laser skin resurfacing developed contact dermatitis to several topical agents. Patch testing was negative on normal skin for contact allergy, suggesting a primary irritant reaction in laser-treated skin. Post-laser hyperpigmentation and erythema were the most noted immediate and mid-term side effects to laser resurfacing. An optimum pretreatment regime includes topical retinoids, skin lightening agents, and, immediately pretreatment, oral anti-herpes simplex medication plus oral antibiotics. An optimum posttreatment regimen includes minimizing topical therapy with the use of dilute acetic acid facial soaks. In addition, oral anti-herpes simplex medications and broad spectrum antibiotics are continued for 7 days post-laser resurfacing.
CONCLUSION: Laser skin resurfacing is an evolving means of treating photodamaged skin. Carefully selected pre- and posttreatment regimens, ideally under dermatologic supervision, are required to obtain optimum results.