Causes and Treatments for Solar Lentigos

By: Amiya Prasad, M.D.

Thank you for your question. You submitted 3 photos and in your question, you describe a situation where you had a solar lentigo treated using CO2 laser approximately 24 days earlier. And with the photos you submitted, you are drawing attention to an area where you say it is still red and that it looks relatively deep. And you are asking what to expect from this situation and apparently this is very close to a very important event, a wedding.

So certainly, I can give you some guidance as to my thoughts as to your situation. And now understand this is in absence of physical examination and as well as knowing as some details about your situation including the laser and the type of treatment, etc that were applied. Just a little bit of background, I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and reconstructive surgeon practicing in Manhattan and Long Island for over 20 years. I can tell you that I have been using the CO2 laser since the original CO2 lasers since the mid 90’s and I can certainly give you a little bit of guidance as to my thoughts.

But before that, just to understand your problem was a solar lentigo and essentially a solar lentigo is a well-defined basically brown spot at a certain level of the skin called the dermal epidermal junction. And basically, it’s consistent solar associated with sun and it’s a concentration of pigment cells that cause this brown discoloration. The modality to treat solar lentigo is essentially to cover several different potential options but in principle you can treat solar lentigo with something like what we did years ago, as straightforward as a chemical peel such as TCA peels or trichloroacetic acid chemical peel or even a more superficial peel but of course you can also use thermal energy devices that translates or transfer light energy into heat energy this includes modalities such as intense pulsed light treatment as well lasers such as Erbium and CO2 laser. So in your situation, just looking at the degree, at your defect in your skin which looks like a crescent shape, I would express some concern. And at first, you should communicate with your doctor.

It’s 24 days since the procedure and there has to be certain thoughts involved as to why your doctor chose CO2 laser and what was the recommendation as far as after care for the treatment. You also state in your question that it was anticipated that your recovery period will be about 1 week. Well judging from the level and depth that appears in the photo, I am concerned that the epidermis of the epithelial part of the healing is just not closing in and that appears that there is some depth to this which concerns to the healing of the dermis. You see, the differentiation you make when you make a decision like this has several variables when it comes to choosing the modality for a procedure like this. The modalities such as pulse light treatment are to focus in the actual pigment of the melanin and procedures that require ablation literally taking off that top layer of skin.

Causes and Treatments for Solar Lentigos

And in concept, basically the body generates new skin that will be smooth. So when you apply a device such as CO2 laser, you are getting relative deep penetration of heat. Now the effect of heat on reepithelialization or repair is certainly an important factor and what was done on the aftercare on your skin is also a factor.

My concern is you might end up with a slight depression on your skin based on this set of photos so you need to meet with your doctor. Your doctor should be able to give you guidance as to what to do. One of the complications of laser treatment is this type of situation where you can have this type of defect or problems with healing. Problems with healing can include problems with crust that forms, problems with inflammation, problems with infection and there are a lot of things that can be factored in. We don’t have to automatically think that the laser itself. And when you think about the term CO2 laser, there are many variables as to the level of energy and the depth which you can apply this energy. So, I think what you need to do is meet with your doctor. I think that as a specialist who has done this for many years, my concern is will you be able to have proper healing to improve the appearance without getting an indentation.

So it is 24 days after the procedure and there is still wound healing going on but usually from my experience, the epithelium would have healed well enough that you wouldn’t see a depression. Your doctor would have done multiple passes because he felt that the level of the pigment may have been a little bit deeper. Again not being there, not being to know the parameters in your situation is a little bit difficult but the communication with your doctor is critical. Understand what happened and maybe your doctor could intervene to help reduce the situation as well as to do something to help to improve the healing process. So I hope that was helpful, I wish you the best of luck and thank you for your question!.

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