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.
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AUTHOR CORRESPONDENCE
Saad Al Mohizearodomani@yahoo.com