There are a number of relative contraindications that the laser physician should consider before treatment. The physician should ascertain that the patient has realistic expectations from the laser treatment. Patients with a history of hypertrophic or keloidal scarring should be treated more conservatively, using test spots and lower fluences. Likewise, patients with a history of recent isotretinoin use should be treated less aggressively.
Any patient with a history of herpes simplex infections should be given prophylactic antiviral therapy prior to any laser treatment at that anatomic site. Patients who regularly take aspirin or anticoagulant therapy should discontinue taking these medications at least 10 days prior to treatment, if possible. If these medications are not discontinued, patients may have more bruising, as these medications can predispose to vessel extravasation after treatment. It is recommended that patients having a history of persistent postinflammatory hyperpigmenta-tion, darkly tanned skin, or skin types greater than Fitzpatrick phototype III, not be treated with lasers having shorter wavelengths, as such individuals are at a greater risk of postinflam-matory hyperpigmentation.
Patients having photosensitivity disorders, or using systemic medications known to be photosensitizing, should be carefully screened.
Although laser treatment in itself is inherently safe in pregnancy, the treatment does cause pain and can be distressing, and is best deferred in some patients until after delivery.
All patients should be instructed to postop-eratively avoid sun exposure and wear a broad spectrum sunscreen of SPF 30 or higher on treated exposed areas.
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