Laser devices are powerful tools that have various indications, but these devices also have the potential to cause significant harm to patients and healthcare providers if not used correctly. Lasers should be used by trained medical professionals in medical setup, providing higher quality care with a lower risk of adverse effects
Physicians and other clinicians should be aware of the risks of complications of laser procedures and knowledgeable about the management of these complications.
The devices used in the Indian skin include : the long-pulse Nd:YAG, diode and Alexandrite lasers and intense pulse light
What are the complications??
The complications of laser procedures may be classified as
1)Immediate (up to 7 days) such as burning sensation, edema, blistering.
2)Transient (1–6 weeks)such as post-inflammatory hypopigmentation or hyperpigmentation and
3)Persistent (after 6 weeks) such as depigmentation, scarring.
Laser procedures should be performed with great caution as the majority of laser procedures are performed for cosmetic purposes, which raises the stakes somewhat because of high patient expectations for optimal results. One should be selective in their choice of candidates for laser therapy and should not perform elective procedures on patients who are excessively tan. Darker-skinned patients are at increased risk of dyspigmentation and should be counseled on this risk.
Nd:YAG lasers have been shown to have the lowest risk of dyspigmentation for dark-skinned patients but should only be used in the hands of experienced laser operators. Strict sun avoidance for two weeks before treatment can reduce the risk of post-inflammatory hyperpigmentation. Hyperpigmentation typically resolves over several months but can be treated with strict sun avoidance, superficial chemical peels, and topical medication. Hypopigmentation may resolve with time and can be covered with makeup, or melanin production may be stimulated with fractionated CO2 laser or narrow-band ultraviolet light treatments.Physicians, physician assistants, and nurse practitioners often operate medical lasers.
Management
Complications such as a burning sensation, pain, edema and crusting can be reduced with a good precooling and postcooling protocol. Laser burns should be recognized early and treated immediately with a moderate potency topical steroid for a few days to reduce the inflammation
Acneform eruptions occur in few patients undergoing laser hair reduction. They arise independently of gender, the number of previous sessions or the presence of polycystic ovarian syndrome. Folliculitis and acneform eruptions may be treated with oral antibiotics for 10–20 days along with topical antibiotics.Postinflammatory hyperpigmentation is treated with topical hydroquinone, kojic or glycolic acid creams by a medical professional. The application of a broad spectrum sunscreen is mandatory.
Post-laser hypopigmentation or depigmentation are anxiety inducing complications which may result after laser hair reduction, pigment lasers or resurfacing lasers. Appropriate delivery of energy using optimal laser settings may reduce the incidence of this complication. Postinflammatory hypopigmentation maybe treated with topical tacrolimus, as it enhances melanocyte migration. The application of 65% trichloroacetic acid on depigmented spots may be successful in repigmenting these patches which are performed under medical professional supervision.
Paradoxical hypertrichosis may occur in 0.6–10% of patients undergoing laser hair reduction and is more common after treatment with intense pulse light. It is more frequent in the head and neck areas (especially on the chin, mandibular and zygomatic areas in patients with darker skin), and in patients with thick dark hair or underlying hormonal imbalance. An uncorrected hormonal abnormality that might be triggering hair growth should be eliminated before labeling a patient as having paradoxical hypertrichosis. It has been suggested that subtherapeutic thermal injury to the surrounding vellus hair stimulates conversion into terminal follicles and inflammatory mediator. Protecting the nonlasered area with cold packs during the procedure may help prevent this complication. Paradoxical hypertrichosis may be treated by using a higher fluence and doubling the number of laser passes on the affected area.
It is important to seek medical professional advice before taking a laser treatment to prevent major complications.