Ulceration of mature surgical scars following nonablative fractional photothermolysis associated with intralesional lidocaine injections

Abstract

Fractional photothermolysis (FP) is an established modality of laser resurfacing. In non-ablative FP (NAFP), a near-infrared laser light, mainly absorbed by aqueous tissues, creates a pattern of epidermal and dermal microscopic thermal wounds, known as microthermal zones (MTZ).1 The tissue surrounding each MTZ is spared from the thermal damage, thus facilitating a more rapid recovery than conventional full-surface laser resurfacing. NAFP has demonstrated promises in improving atrophic, hypertrophic and hypopigmented scars, by normalizing collagenesis.2 Scars from ablative fractional resurfacing (AFP) due to excessive energy/density and bulk heating from treatment overlap have been previously reported.3 There is no published of a ulcer or scar formation associated with a NAFP treatment.4 Here, we report two patients with chronic stable surgical scars who developed ulcerations after non-ablative fractional resurfacing treatment. Both cases were associated with pre-treatment anesthesia with intralesional injections of 1% lidocaine with epinephrine.