Hyperpigmentation may occur post ablative laser resurfacing, especially in those individuals with darker skin tones.3,5,17 A survey completed by fifty-six dermatologists and surgeons showed that topical hydroquinone was the preferred choice to be recommended for prophylaxis, together with diligent physical block sunscreen use and strict sun avoidance.6 Other topical pigment-correction agents that may be used include retinoic, tranexamic, kojic, azelaic, and glycolic acids.6 The panel agreed that pre-procedure hydroquinone, or equivalent, is appropriate for patients with baseline melasma or post-inflammatory hyperpigmentation, but not routinely recommended for darker skin types due to lack of evidence and medicolegal concerns.
Section 2: Pre-Procedure
Pre-screening should include a thorough discussion with the patient, including what to do after the procedure.6 A complete medical history should be taken before a laser or other energy-device treatment is initiated, asking the patient about their history of post-inflammatory hyperpigmentation, excessive scarring, drug allergies, and medical conditions, specifically connective tissue and immune disorders.5,6,11,12 Further, the patient should be asked about previous facial treatments, specifically chemical peels or dermabrasion, and the use of supplements and medication that could increase the risk of complications during the procedure.5,6,11,12 These medications include aspirin, ibuprofen, and vitamin E and should be avoided for at least ten days before the procedure.5,6,11,12
Before the treatment, the reason(s) why the patient is seeking treatment is to be recorded, including the expectations from the procedure.6 This is followed by a detailed discussion about possible side-effects, complications, and preventive measures and signing the consent form (Table 2).6 Both clinical and photographic outcome measurements are used to evaluate the primary outcome of laser/intense pulsed light (IPL) procedures.5,6,11,12
Section 3: Choose and Perform the Intra-Procedure
Patients who don’t spend time outside can start laser treatment on the same day of consultation. According to the panel, antimicrobial prophylaxis is only required in specific circumstances (eg, infection, heart disease) for ablative procedures. The use of antiseptic pre-treatment is a subject for debate since emerging antimicrobial resistance (AMR) is a growing concern, and dermatologists are among the most frequent prescribers of topical antibiotics.21
AMR has become one of the most important determinants of outcomes in patients with infections.19-22 The cost of AMR is immense, both economically and for patients’ quality of life.The continued rise in AMR would cost up to 100 trillion United States Dollars.19 Global consumption of antibiotics in human medicine rose by nearly 40% between 2000 and 2010.23
Resistance is often associated with prolonged use of antibiotics or common strains of bacteria.24 AMR is facilitated by various factors, including inappropriate use of medicines (eg, using antibiotics for viral infections), sharing antibiotic prescriptions between patients, low-quality medicines, inappropriately assigned prescriptions, and inadequate infection prevention and control.24
Antimicrobial stewardship is defined as “the optimal selection, dosage, and duration of antimicrobial treatment that results
Section 2: Pre-Procedure
Pre-screening should include a thorough discussion with the patient, including what to do after the procedure.6 A complete medical history should be taken before a laser or other energy-device treatment is initiated, asking the patient about their history of post-inflammatory hyperpigmentation, excessive scarring, drug allergies, and medical conditions, specifically connective tissue and immune disorders.5,6,11,12 Further, the patient should be asked about previous facial treatments, specifically chemical peels or dermabrasion, and the use of supplements and medication that could increase the risk of complications during the procedure.5,6,11,12 These medications include aspirin, ibuprofen, and vitamin E and should be avoided for at least ten days before the procedure.5,6,11,12
Before the treatment, the reason(s) why the patient is seeking treatment is to be recorded, including the expectations from the procedure.6 This is followed by a detailed discussion about possible side-effects, complications, and preventive measures and signing the consent form (Table 2).6 Both clinical and photographic outcome measurements are used to evaluate the primary outcome of laser/intense pulsed light (IPL) procedures.5,6,11,12
Section 3: Choose and Perform the Intra-Procedure
Patients who don’t spend time outside can start laser treatment on the same day of consultation. According to the panel, antimicrobial prophylaxis is only required in specific circumstances (eg, infection, heart disease) for ablative procedures. The use of antiseptic pre-treatment is a subject for debate since emerging antimicrobial resistance (AMR) is a growing concern, and dermatologists are among the most frequent prescribers of topical antibiotics.21
AMR has become one of the most important determinants of outcomes in patients with infections.19-22 The cost of AMR is immense, both economically and for patients’ quality of life.The continued rise in AMR would cost up to 100 trillion United States Dollars.19 Global consumption of antibiotics in human medicine rose by nearly 40% between 2000 and 2010.23
Resistance is often associated with prolonged use of antibiotics or common strains of bacteria.24 AMR is facilitated by various factors, including inappropriate use of medicines (eg, using antibiotics for viral infections), sharing antibiotic prescriptions between patients, low-quality medicines, inappropriately assigned prescriptions, and inadequate infection prevention and control.24
Antimicrobial stewardship is defined as “the optimal selection, dosage, and duration of antimicrobial treatment that results
