As mentioned, laser has a wide range of applications; however, studies which have focused on efficacy of laser in scar removal have reported different results, some even have reported scar recurrence in 90% of patients. In addition, laser therapy has some limitations and is not applicable in all people. For example, the following individuals are not considered good candidates for laser therapy:
1) Darker skin Phototypes
People with darker skin tones (phototypes IV or greater) have a greater amount of epidermal pigments which interfere with the absorption of laser; as a result, the amount of energy effectively delivered to dermal scar tissue is reduced. Thus, the efficacy of laser treatment is also reduced. In addition, these people are prone to postinflammatory hyperpigmentation.
2) Concurrent inflammation or infection
Any infection or inflammation must be treated prior to performing laser surgery. Bacterial or viral infection (like herpes simplex), may be spread by laser irradiation. In case of concurrent inflammatory skin disorders (e.g. cystic acne, psoriasis, dermatitis), the condition may worsen with laser treatment; in addition, dermal inflammation may affect postoperative healing and clinical effects.
3) People who use certain medications
Isotretinoin is one of the drugs used by people with severe acne. This drug can impair wound healing which may result in development of new scars. Thus, patients must have completed their last course of Isotretinoin at least 6 months prior to laser resurfacing.
4) Smoking
People with a history of smoking in the past year are not good candidates for laser therapy, since they have impaired wound healing which may lead to scar formation.
The most common complications of laser therapy are mentioned below:
- Pain
- Prolonged erythema
- Prolonged edema
- Blister formation
- Eczema and dermatitis
- Acne
- HSV attack
- Superficial burn and erosion
- Hypopigmentation
- Post inflammatory hyperpigmentation
- Purpura and telangiectasia
- Scar formation