on patient preference. To reduce the risk of infection, we suggest patients take a two-week course of oral antibiotics following each treatment and applied topical mupirocin to the treated area three times daily for three days. To prevent HSV outbreaks, we suggest prophylactic oral valacyclovir 1 gram twice daily for 10 days starting the day before each procedure. We also advise application of triamcinolone 0.1% ointment to the treated area immediately following the procedure and sun avoidance to promote healing and to minimize PIPA and photodamage. It is important to set patient expectations that the pigmentary changes associated with the milia-may not fully resolve.
Skin of color patients may be particularly sensitive to side effects from laser treatments, including erythema, blistering, and PIPA.9 Dermatologists may prefer to begin their skin of color patients on conservative laser parameters to determine their patient’s response before gradually increasing dosing, power, and frequency.
We present a new treatment method for addressing the aesthetic concerns of HED patients using fractional CO2 ablative laser with LADD triamcinolone 0.1%. We advise approximately three treatments spaced at a minimum of six weeks apart to allow time for the skin to heal between sessions and to prevent scarring. We suggest following up with patients one week after each treatment to monitor progress and address any adverse events. Patients may require additional sessions to achieve or maintain their desired results.
This combination approach equips dermatologists with a practical treatment for their HED patients. This treatment can be administered safely with minimal risk of side effects and serious adverse events. This case demonstrates that fractional CO2 ablative laser with LADD triamcinolone 0.1% can be effective at improving the milia facial skin rash caused by HED that has previously been difficult to treat, while also improving HED patients’ self-esteem and quality of life.
DISCLOSURES
The authors have no conflicts of interest to declare.
REFERENCES
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- Mehta S, Agarwal N, Khare AK, et al. Hypohidrotic ectodermal dysplasia in association with milia. Indian J Dermatol Venereol Leprol. Sep-Oct 2014;80(5):483.
- Wright JT, Grange DK, Fete M. Hypohidrotic Ectodermal Dysplasia. In: Adam MP, Mirzaa GM, Pagon RA, et al, eds. GeneReviews(®). University of Washington, Seattle.
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- Laubach HJ, Tannous Z, Anderson RR, et al. Skin responses to fractional photothermolysis. Lasers Surg Med. 2006;38(2):142-9.
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- Zaouak A, Benmously R, Hammami H, et al. A case of herpes simplex virus reactivation after fractional ablative carbon dioxide laser to treat a burn scar. J Cosmet Laser Ther. 2019;21(3):145-146.
- Maninder K, Richa R, Dinesh AP, et al. Factors affecting the outcome of fractional carbon dioxide laser resurfacing of various types of scars in skin of color. J Cosmet Dermatol. 2022;21(9):3842-3847.
AUTHOR CORRESPONDENCE
Jared Jagdeo MD MS jrjagdeo@gmail.com
