There are few true contraindications. A personal or family history of vitiligo should be considered a relative contraindication. Theoretically, a Koebner phenomenon could occur and bring out vitiligo in the laser-treated areas. Scle-roderma patients should be counseled that ablative resurfacing could exacerbate their disease, although reports of successful treatment exist (T. Alster, personal communication). Darker-skinned patients need to understand the likelihood of hyperpigmentation, which is usually temporary but may be long-lasting. The use of hydroquinone preparations with vitamin A derivatives, glycolic acid and/or topical corti-costeroids, and good sunscreen minimized this problem. Patients with very fair and fine-pored skin appear to be at greatest risk for delayed hypopigmentation, which can be permanent. Unrealistic expectations and inability or unwillingness to perform wound care are contraindications for ablative skin resurfacing.
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