Ablative Fractional Lasers with Corticosteroids

The charts below show the chances of developing various side effects from ablative fractional laser with corticosteroid treatment.^1-5 For some side effects, we currently do not have enough data to provide a percentage.

Certain/Likely Side Effects (% = Incidence)

Possible/Rare Side Effects

*Thinning of the skin (atrophy): Thinning of the skin after ablative fractional laser with corticosteroid treatment makes the skin look sunken in. In some cases, this side effect may take longer to disappear.

Studies:   

Five studies have looked at the side effects of ablative fractional laser with corticosteroid treatment.

• Study 1:
  
  
  • Authors: Zhou et al.¹
  • Total # of patients: 155
  • # of female patients: 79
  • # of male patients: 76
  • Age of patients: 14-65
  • Laser type: Ablative fractional CO₂ laser (30 MJ, density range: 10 %) with 40mg/ml of the triamcinolone, intralesionally or topically
  • Duration of treatment and follow-up: 3 treatments, follow-up for 1 month
  • Side effects:
    
    • Oozing from wounds: 29.9%
    • Bleeding: 20.9%
    • Swelling (edema): 12.5%
• Study 2:
  
  
  • Authors: Alexander et al.²
  • Total # of patients: 25
  • # of female patients: 7
  • # of male patients: 18
  • Age of patients: 20-50
  • Laser type: Ablative fractional CO₂ laser (5 to 30 mJ of energy; density: 5% to 30%) followed by intralesional injection of 10 mg/mL triamcinolone
  • Duration of treatment and follow-up: 4 treatments, no follow-up
  • Side effects:
    
    • Pain: 16%
    • Skin darkening (hyperpigmentation): 8%
    • Scar regrowth: 8%
    • Skin lightening (hypopigmentation): 4%
• Study 3:
  
  
  • Authors: Waibel et al.³
  • Total # of patients: 20
  • # of female patients: (not reported)
  • # of male patients: (not reported)
  • Age of patients: More than 18
  • Laser type: Ablative fractional laser CO₂ laser (fluence: 15mJ, density 10%) with topical 20 mg/mL of triamcinolone solution
  • Duration of treatment and follow-up: 3 treatments, follow-up for 3 months
  • Side effects:
    
    • Thinning of the skin (skin atrophy): (percentage not reported)
    • Spider veins (telangiectasia): (percentage not reported)
• Study 4:
  
  
  • Authors: Majid et al.⁴
  • Total # of patients: 10
  • # of female patients: 7
  • # of male patients: 3
  • Age of patients: 5-12
  • Laser type: Ablative fractional CO₂ laser (energy: 90 to 150 mJ at 30 W power, density: 8.4%) followed by 10 mg/ml of topical triamcinolone suspension
  • Duration of treatment and follow-up: 3-5 treatments, follow-up for 3 months
  • Side effects:
    
    • Pain during the procedure: 40%
    • Fear about the procedure: 20%
    • Transient post-inflammatory hyperpigmentation (skin darkening): 10%
• Study 5:
  
  
  • Authors: Abd El-Dayem⁵
  • Total # of patients: 30
  • # of female patients: (not reported)
  • # of male patients: (not reported)
  • Age of patients: 19-50
  • Laser type: Ablative fractional 2940 nm Er: YAG laser (fluence: 250-300 mJ, ablation depth: 30-40 μm) followed by topical application of triamcinolone (10 mg/mL) 
  • Duration of treatment and follow-up: 4 treatments, follow-up for 3 months
  • Side effects:
    
    • Skin lightening (hypopigmentation): 23.33%
    • Skin darkening (hyperpigmentation): 20%
    • Spider veins (telangiectasia): 6.67%
    • A localized area of white depigmented skin (leukoderma): 3.33%

Study 1: In a study published in 2023 in the journal Heliyon, Zhou and colleagues treated 155 patients with hypertrophic scars with ablative fractional CO₂ laser followed by corticosteroids. Patients were divided into 2 groups, one receiving laser and topical application of 40 mg/ml of triamcinolone 2 hours after the procedure, and group 2 treated with laser and injection of  10-40 mg of triamcinolone. All patients underwent 3 treatment sessions in 4-week intervals and were followed for 1 month after the last session. The tables below show reported adverse effects among groups.¹

Ablative fractional CO₂ laser with topical corticosteroid treatment

Ablative fractional CO₂ laser with intralesional corticosteroid treatment

Study 2: In a study published in 2019 in the Journal of Cosmetic Dermatology, Alexander and colleagues treated 25 patients with keloids and hypertrophic scars with ablative fractional laser followed by intralesional corticosteroids. All patients received 4 treatment sessions in 4-week intervals but were not followed after the last treatment session. The authors reported that 16% of patients experienced pain, 8% skin darkening (hyperpigmentation), and 4% skin lightening (hypopigmentation). Importantly, the authors also observed scar regrowth in 8% of treated patients. This side effect happened in males and authors believe that it could be overcome with more sessions of ablative fractional laser with intralesional corticosteroid treatment.²

Study 3: In a study published in 2018 in the journal Dermatologic Surgery, Waibel and colleagues treated 20 patients with raised scars with ablative fractional CO₂ laser followed by topical 20 mg/mL of triamcinolone solution. A corticosteroid was applied immediately after the laser session. All patients received 3 treatments in 4-week intervals and were followed up for 3 months after the last session. While the treatment was generally well tolerated, some patients experienced thinning of the skin (skin atrophy) and spider veins (telangiectasia). However, the exact number of patients who developed these adverse effects was not reported.³

Study 4: In a study published in 2017 in the journal Dermatologic Surgery, Majid and colleagues treated 10 young patients, aged 5 to 12 years with ablative fractional laser and 10 mg/ml of topical triamcinolone suspension. All patients received 3 to 5 treatment sessions in 4-week intervals and were followed up for an additional 3 months. The authors reported that treatment was well tolerated, but some patients experienced pain during the procedure, fear about the procedure, and transient post-inflammatory hyperpigmentation (skin darkening).⁴

Study 5: In a study published in 2020 in the Journal of Cosmetic Dermatology,Abd El-Dayem and colleagues treated 30 patients with keloids with ablative fractional Er:YAG laser followed by topical application of triamcinolone (10 mg/mL). All patients received 4 treatment sessions in 4-week intervals and were followed up for an additional 3 months. The authors reported that patients experienced short-term side effects including skin lightening or darkening, and spider veins. One patient reported the occurrence of a localized area of white depigmented skin.⁵