Ablative carbon dioxide laser treatment (for example the Lumenis Ultrapulse laser) can be an effective treatment for skin lesions. Ablative means that the entire surface layer of the skin is removed using the laser. Immediately following the treatment the area appears raw and whitish/brown. There will be some bleeding. The area heals over a number of weeks and there can be ongoing blistering, crusting and oozing during this time.

The area heals by forming scar tissue. In many cases this can improve the appearance, however it is always advisable to treat a small number of lesions or smaller area first and then assess healing prior to treating a larger area.

Fully ablative laser treatment is associated with some significant risks and it is important that you read the following information carefully when deciding whether it is the right treatment for you.

Alternative treatments include doing nothing, electrocautery, surgical treatments and treament with trichloroacetic acid.

Contraindications

Certain conditions significantly increase the risks of treatment. It is important to inform Dr Lynch if any of the following apply :-

• Hypertrophic or keloidal scarring (lumpy scars): If you have previously experienced hypertrophic or keloid scars you can be at risk of developing scars from minor injuries such as laser treatment.
• Treatment with isotretinoin (roaccutane) within the last year: This increases the risk of unsightly scarring and poor healing.
• Tanning / sun exposure: Tanning increases the risks of laser treatment. Inform Dr Lynch if you have been in the sun, have had a tan, or a sunburn, within the last 4 weeks.
• Recurrent coldsores: Coldsores can be triggered by laser treatments. If you frequently experience herpes virus infection (coldsores) near to the site of treatment then you may need antiviral prophylaxis to decrease this risk.
• Pregnancy: It is not recommended to have laser treatment during pregnancy due to an increased risk of complications.
• Important events: Due to the risks of unsightly changes in appearance of the skin it is not advisable to have treatment shortly before important events such as weddings or important business meetings etc.
• Vitiligo or other inflammatory skin disease such as psorisasis or lichen planus: If you suffer from an inflammatory skin disease, laser treatment can cause this to be triggered at the site of treatment . It is essential to inform Dr Lynch so that the risks and benefits of treatment can be discussed.

Risks

• Pain (common): The treatment is performed with injected local anaesthetic but there may still be pain during the procedure or afterwards. Pain can persist for a number of days. Very rarely pain may persist for a longer period or fail to resolve.
• Bruising, bleeding, blistering, crusting (common): Immediately following the treatment, the surface of the skin will appear red, swollen and inflamed with some bleeding and crusting. The area will generally heal over a number of weeks, however there can be ongoing blistering, crusting and oozing during this time.
• Redness and inflammation (common): The treated area will be red, sore and inflammed immediately after treatment. In most cases this will persist for 1-2 days, although rarely redness can last longer - it will usually resolve within weeks, however it can remain for months or rarely can be permanent.
• Infection: There may be bacterial or viral (herpes) infection. Very rarely there may be less common infections that fail to respond to treatment.
• Darkening of the skin or loss of pigmentation (common): The treated area may become hyperpigmented (darker), hypopigmented (lighter) or redder than the normal skin color. There may be patchy changes in skin pigmentation. In most cases pigmentary changes will resolve within weeks-months, however occasionally they can be permanent. Risks are higher in those with darker skin types.
• Scarring (common): Scarring can occur and rarely can result in unsightly scar formation. These may be raised or lumpy (including hypertrophic or keloid scar), depressed, different in color from the adjacent skin (redder/lighter/darker), or different in texture (for example more shiny) in comparison with the adjacent skin.
• Infection (uncommon): There is a risk of herpes virus reactivation (coldsores). There is also a risk of bacterial or yeast infection.
• Nodule or cyst formation, acne (uncommon): Ablative laser resurfacing or the greasy moisturisers used afterwards can trigger nodule or cyst formation (lumps beneath the skin surface) or acne lesions.
• Sun sensitivity (common): There may be increased sensitivity to sunlight. It is essential to avoid excessive sunlight exposure and to use a sunblock cream for a minimum of 6 weeks after treatment.
• Failure to Achieve Desired Results, worsening of appearance: It is possible that this procedure does not lead to the degree of improvement that you desire. You may feel that the overall appearance has been worsened by laser treatment.
• Recurrence of the lesion: The treated lesions may recur or you may develop additional lesions at other sites.
• Hair loss: If the treated area is in a hair-bearing site there is a likelihood of hair loss.

Additional risks

Test patch

Due to the potential for complications it is always advisable to attend for a small test patch of treatment first and then assess healing prior to treating a larger area. A test patch reduces but does not eliminate the risk of complications.

Aftercare

• Keep the area covered for 48 hours then remove the dressing and wash in the shower daily with an antibacterial wash such as Dermol 500.
• During the initial phase of healing apply plain vaseline (from a new pot) multiple times a day to keep the area moist and prevent scabbing.
• Avoid excessive sunlight exposure and use a sunblock cream for a minimum of 6 weeks after treatment.
• Avoid vigourous exercise or heat exposure until the area has healed.