Data highlighting contraindications from aesthetic procedures scarce

Key Points

Sofia, Bulgaria - Dermatologists need more research into contraindications and complications of aesthetic procedures, particularly those used to treat medical conditions, according to an expert. However, she adds, such studies will be difficult to produce.

Traditionally, "Aesthetic dermatology and clinical dermatology are two separate branches on the same river," says Jana Kazandjieva, M.D., associate professor of dermatology, Medical University of Sofia, Bulgaria. However, "There are many advantages when we try to build a bridge between them, because many skin diseases could be treated successfully with aesthetic procedures."

To maximize this connection, though, she says dermatologists need better knowledge about possible side effects and contraindications of aesthetic procedures in this context.

Controversy has arisen around the relation between many skin diseases and aesthetic treatments, Dr. Kazandjieva says. For example, "Usually we have difficulties when patients have diseases with expressed Koebner phenomenon." In psoriasis and vitiligo, she says, excimer laser provides benefits.

"On the other hand," she says, "Procedures like laser hair removal or dermabrasion may induce Koebner phenomenon in patients with these diseases."

Therefore, Dr. Kazandjieva says when a patient with psoriasis wants laser hair removal, "My rule is that the patient's psoriasis should be in remission for at least one month."

Additionally, Dr. Kazandjieva says the patient should have no personal or family history of Koebner phenomenon occurring in the context of psoriasis. Dermatologists also should treat small test areas first, and avoid high laser energy.

Vitiligo

Regarding patients with vitiligo, "I suggest the patient should have no new vitiligo lesions for at least six months, no personal experience of Koebner phenomenon or other systemic autoimmune disease, and no family history of vitiligo, Dr. Kazandjieva says. She says dermatologists also should choose patients without extensive vitiligo involvement and use gentle treatment parameters.

For patients with psoriasis or vitiligo who want laser treatments, she says, "Informed consent is necessary. Also, patients with vitiligo should know that the white hair on affected areas will not respond to the laser energy."

Unfortunately, little research regarding patients with psoriasis or vitiligo who undergo laser procedures exists, because such patients are rare.

"That's why there are no large studies," Dr. Kazandjieva says. "We need more published cases to summarize the data and help us form our own conclusions."

Additionally, she says recent publications indicate that exposure to visible light in the near-UV spectrum can cause pigmentation changes. "It's a tricky topic - should you use laser energy for hyperpigmentation in light of these data?"

Regarding a rather heated discussion among several experts at the European Academy of Dermatology and Venereology annual meeting in October, Dr. Kazandjieva says, "We agreed that you should know the depth of the hyperpigmentation. Only very superficial hyperpigmentation can be treated with laser."

Treating deeper hyperpigmentation rarely works, she says, and it creates a risk of postinflammatory hyperpigmentation.

Laser manufacturers might claim that their lasers can be used for hyperpigmentation, Dr. Kazandjieva says, "But when you ask laser specialists, many of them will tell you that hyperpigmentation is very difficult to remove with a laser."

Moreover, she says that although small case series performed with the same laser exist, dermatologists need more comprehensive research comparing several devices against each other. But such studies remain rare because few researchers have five to eight lasers and intense pulsed light (IPL) devices at their disposal, she says.