Objectives: How to use CO2 laser effectively and safely in black patients and in those with melasma and post-inflammatory hyperpigmentation.
Introduction: Treating melasma, post-inflammatory hyperpigmentation (PIH), and acne scars in phototypes IV and V with fractional CO₂ laser is controversial due to pigmentation risks. However, with proper assessment, skin preparation, and parameter control, safe and effective outcomes can be achieved in high-risk skins.
Materials / method: Patients were evaluated for risk factors and underwent pre-treatment skin conditioning with oral and topical agents. CO₂ laser sessions were performed using tailored parameters depending on indication (melasma, PIH, scars). Drug delivery was combined in select cases to enhance results and accelerate recovery.
Results: Discromias were rare and mild. Most patients had visible improvement in skin texture, pigmentation, and scar depth. No cases of permanent hyperpigmentation were reported. Outcomes confirm that with proper protocol, CO₂ laser is safe and effective in darker phototypes and inflammatory pigmentation conditions.
Conclusion: Fractional CO₂ laser, when used with clinical judgment and individualized parameters, is a safe therapeutic option for melasma, PIH, and acne scars in phototypes IV and V. Proper skin preparation, conservative protocols, and follow-up are key to minimizing complications and achieving optimal results.
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