Case of the month
Treating a blistering laser burn with post-inflammatory hyperpigmentation in skin-of-color can be very challenging.
There is no perfect protocol, so I will tell you how I successfully managed this case so that you may use it as a general template, to be adjusted by your experience, expertise, and your patient’s response, should you ever need it.
Dr. Crutchfield’s Treatment Protocol to Treat a blistering laser burn with post-inflammatory hyperpigmentation in skin-of-color:
For the first 2 weeks I used Mupirocin ointment, BID topically, and Alcortin A cream QD. I also covered him with Keflex, 500 mg TID for 10 days.
I added Biafine cream BID for 14 days and continued the Alcortin A cream, QD.
I started Lauripure ointment BID and discontinued the Alcortin A cream.
I reduced the Lauripure ointment to QD and started Dermatix Scar Cream QD, and Phyto + hydrating botanical gel, BID (to start treating the hyperpigmentation). I also started Alclometasone cream QD. and initiated narrow band UVB phototherapy treatments to also even out dyschromia, 2-3x/week, starting at 150mJ, increasing 15 mJ per treatment with a maximum of 420mJ. He completed a total of 18 phototherapy treatments.
I discontinued Aclometasone cream and increased Dermatix scar cream to BID. I discontinued the Phyto+ gel, and started a topical compounded cream for hyperpigmentation containing: hydroquinone 6%, retinoic acid 0.05%, kojic acid 3%, and hydrocortisone 0.5%. I instructed him to use this compounded cream twice daily.
The patient was essentially back to normal and was extremely grateful, and discontinued all treatments.
Charles E. Crutchfield III, MD
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1185 Town Centre Drive, Suite 101
Eagan, MN 55123 USA
Phone: (651) 209-3600 Fax: (651) 209-3601
Hours: Monday-Friday 8am-5pm
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