Dystrophic calcification and accentuated localized Argyria after fractionated carbon dioxide laser therapy of hypertrophic scars

• Published in: JAMA dermatology (Chicago, Ill.) Vol. 150; no. 3; p. 312
• Main Authors: Shaub, Amanda R, Brown, Patrick J, Kobayashi, Todd T, Lewin-Smith, Michael R, Lupton, George P, Hivnor, Chad M
• Format: Journal Article
• Language: English
• Published: United States 01-03-2014
• Subjects: Adolescent; Argyria - etiology; Argyria - pathology; Bandages - adverse effects; Biopsy, Needle; Calcinosis - etiology; Calcinosis - pathology; Calcinosis - therapy; Cicatrix, Hypertrophic - etiology; Cicatrix, Hypertrophic - pathology; Cicatrix, Hypertrophic - radiotherapy; Female; Follow-Up Studies; Humans; Immunohistochemistry; Lasers, Gas - adverse effects; Low-Level Light Therapy - adverse effects; Low-Level Light Therapy - methods; Risk Assessment; Severity of Illness Index; Silver - adverse effects; Stevens-Johnson Syndrome - complications; Stevens-Johnson Syndrome - diagnosis; Stevens-Johnson Syndrome - therapy; Treatment Outcome
• ISSN: 2168-6084
• DOI: 10.1001/jamadermatol.2013.8044

Fractionated, ultrapulsed carbon dioxide (CO2) laser therapy is a powerful tool for the treatment of scars. Common adverse effects of this therapeutic modality have been previously documented. We describe 2 unreported adverse effects of ultrapulsed CO2 laser treatment of mature scars in a patient previously treated with silver-impregnated dressings.
A teenage survivor of toxic epidermal necrolysis presented with faint but diffuse dyschromia clinically and histologically consistent with localized argyria secondary to silver-impregnated dressings used years earlier. The patient was subsequently treated with fractionated CO2 for her scarring, but her hyperpigmentation worsened with each treatment. A subsequent biopsy specimen revealed a zone of dystrophic calcification with adjacent pseudo-ochronotic fibers that were not appreciated on biopsy specimens taken before CO2 laser treatment, suggesting unique complications not previously reported.
We present 2 unique complications secondary to ultrapulsed, fractionated CO2 laser treatment in a patient previously treated with silver-impregnated dressings: (1) the appearance of pseudo-ochronotic fibers in areas of worsening pigmentation and (2) evidence of dystrophic calcification limited to columns of fractionated laser ablation. Therefore, a history of argyria or treatment with silver-impregnated dressings should be considered before treatment with fractionated CO2 lasers.