The Effect of Menstrual Cycle on Laser Induced Hyperpigmentation

December 2013 | Volume 12 | Issue 12 | Editorials | 1335 | Copyright © December 2013


Saad Al Mohizea MD

Department of Dermatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia

table 1
which usually coincide with more intense treatments may predispose to hyperpigmentation.
Two patients developed mild hypopigmentation in all treatment sites. In both patients it was observed that the hypopigmentation was localized to the treatment area at the Centre, with a rim of hyperpigmentation surrounding it. Perhaps this could be explained by the fact that maximal heating occurs at the Centre where a certain threshold is exceeded, and hypopigmentation occurs. Away from the center and below that threshold, melanocytes are stimulated and hyperpigmentation occurs. The laser parameters implemented in this study are not routinely used in clinical practice, but have been used in this study to induce hyperpigmentation in small treatment areas. After all, the aim of the study was not to measure the rate of laser-induced hyperpigmentation but to detect any effect of menstrual cycle on the risk of developing hyperpigmentation. The other interesting finding is that unlike in PIH, when hypopigmentation occurred, it did in all areas regardless to the menstrual phase, probably because it is more related to the laser settings.
The biggest challenge was to score the four treatments in a standardized manner. Since the treatments were given at different time points, and the pigmentation in each treatment site evolves at a different time frame, it was important to score later (3 months), where this issue is less pertinent. Nevertheless, the score pattern didn’t change dramatically from 2 to 3 months further undermining any time bias. Furthermore, if the menstrual cycle was irrelevant to pigmentation risk, a pattern were the scores were the same allover or trending to a higher or lower score from the first to the last treatment is more likely.
Even though the study was done on a fractionated CO2 laser, such results might be extrapolated to other lasers and other surgical procedures such as chemical peels and cryotherapy where PIH is a possibility. Likewise, other complications might be linked to menstruation. For example prolonged erythema and crusting seen post hair removal precedes hyperpigmentation and itself might be related to the timing of the menstrual period. Other sporadic complications such as paradoxical hypertrichosis and folliculitis might also be influenced by hormonal variations.
One might argue that these findings are mere random events. Stress, sun exposure and other hidden factors may play a role too. It would be interesting to duplicate these results on the same patients at later menstrual periods. In conclusion, a larger study is necessary to confirm the association of laser induced post inflammatory hyperpigmentation to menstruation and define the days at which it is safest to have laser treatments.

Disclosures

The author has not disclosed any relevant conflict of interest.

References

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AUTHOR CORRESPONDENCE

Saad Al Mohizearodomani@yahoo.com