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

Abstract

IMPORTANCE:

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.

OBSERVATIONS:

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.

CONCLUSIONS AND RELEVANCE:

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.

• Authors: Amanda R Shaub, Patrick J Brown, Todd T Kobayashi, Michael R Lewin-Smith, George P Lupton, Chad M Hivnor
• Journal: JAMA dermatology (JAMA Dermatol) Vol. 150 Issue 3 Pg. 312-6 (Mar 2014) ISSN: 2168-6084 [Electronic] United States
• PMID: 24402614 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Silver

Topics

• Adolescent
• Argyria (etiology, pathology)
• Bandages (adverse effects)
• Biopsy, Needle
• Calcinosis (etiology, pathology, therapy)
• Cicatrix, Hypertrophic (etiology, pathology, radiotherapy)
• Female
• Follow-Up Studies
• Humans
• Immunohistochemistry
• Lasers, Gas (adverse effects)
• Low-Level Light Therapy (adverse effects, methods)
• Risk Assessment
• Severity of Illness Index
• Silver (adverse effects)
• Stevens-Johnson Syndrome (complications, diagnosis, therapy)
• Treatment Outcome