Long-term hypopigmentation induced by diode laser photo-epilation

Transient pigmentary changes have been observed after diode laser photo-epilation, with transient hyperpigmentation (21%) being more frequent than hypopigmentation (8%). Patients with darker skin phototypes (IV–VI on the Fitzpatrick scale) have a higher incidence of side effects. Hypopigmentation is due to a transitory cessation in melanin production and the mean clearance time is about 3 months. We present a case of long-term hypopigmentation induced by laser diode photo-epilation. A 22-year-old Caucasian female, phototype III (Fitzpatrick scale), with localized hypertrichosis on her forearms and no history of recent sunbathing or PUVA exposure, was submitted to our clinic for hair removal to be carried out by two monthly sessions with a diode laser. The applied laser technique emits a wavelength of 800 nm, has a pulse width of 5–30 ms, a spot size of 9 3 9 mm, and a 5°C chilled sapphire tip (LightsheerTM, Coherent Inc). During the Ž rst treatment session she received 286 pulses at a  uence energy of 23 J/cm. Immediate whitening, vesiculation, or forced epidermal separation (Nikolsky’s sign) was not observed during the procedure. Aloa vera gel and sunscreen (SPF 50) was applied to the skin immediately after the treatment, and the patient was instructed to continue to do so for 1 week, after which time she continued using only a sunblocker. Avoidance of sun/PUVA exposure for 2 weeks after treatment was recommended. One month later, during the second treatment session, she received 228 pulses at a  uence energy of 32 J/cm. Mild erythema was the only immediate side effect observed. However, 1 week postoperatively she complained about cutaneous hyperpigmented brown lesions on both forearms (Figure 1). Two weeks postoperatively, clinical examination demonstrated numerous hypopigmented round lesions on both forearms. At this time a topical corticosteroid cream (clobetasol 17-propionate 0.05%; ClovateTM, Medeva Pharma, Madrid, Spain) was introduced, twice daily, during two 10-day cycles. However, the hypopigmentation persisted (Figure 2). At that time she was instructed to maintain the sunscreen only application. By the Ž fth postoperative month no improvement of the hypopigmentation had occurred. Journal of Cutaneous Laser Therapy 2001; 3: 9–10 © Journal of Cutaneous Laser Therapy. All rights reserved ISSN 1462-883X 9