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:

Initial Approach

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.

Day 15

I added Biafine cream BID for 14 days and continued the Alcortin A cream, QD.

Day 30

I started Lauripure ointment BID and discontinued the Alcortin A cream.

Day 45

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.

Day 60

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.

Day 90

The patient was essentially back to normal and was extremely grateful, and discontinued all treatments.

Charles E. Crutchfield III, MD

 

For more cases of the month

Dermatology Case of the Month Archive by Charles Crutchfield III, MD