Prolonged Erythema After Facial Laser Resurfacing or Phenol Peel Secondary to Corticosteroid Addiction

Background. Prolonged persistent erythema postprocedure using phenol or carbon dioxide (CO₂) lasers occurs frequently and the reasons have not been fully ascertained.
Objective. To describe patients whose postoperative care consisted of prolonged use of topical corticosteroids and to assess the outcome of cessation of this medicine.
Methods. Twelve patients who underwent CO₂ laser resurfacing or phenol peels to their face are presented. All patients were seen between 3 and 30 months after the procedures were performed. All dressings, wound care, and other medicaments had been stopped prior to being seen. Most were patch tested to a wide variety of chemicals including corticosteroids, topical medications, and preservatives. They were observed during the poststeroid cessation period and the clinical response is described.
Results. All patch testing showed insignificant results. All postpeel patients cleared within 6 months of steroid cessation, experiencing several flares of erythema before the end result. Three of the six laser resurfacing patients cleared fully within 12 months and three are still being followed. The erythema and severe burning in the patients that cleared stayed clear during long-term follow-up. No scars or atrophy were seen.
Conclusion. The use of topical corticosteroid preparations postoperatively in peel and resurfacing patients is believed to be a major cause of prolonged erythema, dermatitis, burning, and telangiectasias in these patients. The mechanism is believed to be one of vasoconstriction/vasodilatation secondary to the corticosteroids through a nonintact barrier.