Side effect of laser treatment

Patient description

A 38-year-old female patient, Fitzpatrick phototype V, under treatment for familial hypertension

Case description

She presented yesterday for consultation regarding a complication following laser tattoo removal of her eyebrows. The patient reported undergoing six sessions of Q-switched laser targeting the black pigment. After initial clearance of the black ink, she noticed the emergence of a red hue in the treated area.

Subsequently, the treating physician performed a KTP laser session to address the residual (as she defined it) red pigment. In the weeks following this intervention, the patient observed progressive intensification of erythema. Upon returning to the clinic, a diagnosis of secondary infection was made, and a topical antibiotic cream was prescribed.

At my evaluation, conducted two months after the last laser session, the clinical picture revealed persistent erythematous discoloration with dermoscopically evident telangiectasias interspersed with white and yellowish areas. The patient also provided photos made previously, which showed a clinical status consistent with the current in-person findings. Please, share your opinions on diagnosis and treatment.

I have my own diagnostic hypothesis, but I prefer to hear your opinion first, without influencing your reasoning.