If the patient has a history of collagen vascular diseases (eg, lupus, scleroderma, keloid formation) or immunologic abnormalities such as vitiligo, laser treatment may need to be avoided because these conditions can cause problems with healing and can be relative contraindications to laser resurfacing.
Evaluation of facial skin pigmentation before laser resurfacing is paramount to successful results. Pigment can be inherited ethnically or acquired as in melasma or Addison disease. A higher degree of preablative pigmentation increases the risk of hyperpigmentation and hypopigmentation (see image below) after laser resurfacing.
Fitzpatrick devised a description of skin types known as the Fitzpatrick skin type classification. This classification denotes 6 different skin types, skin color, and reaction to sun exposure.
•Type I (very white or freckled) - Always burn
•Type II (white) - Usually burn
•Type III (white to olive) - Sometimes burn
•Type IV (brown) - Rarely burn
•Type V (dark brown) - Very rarely burn
•Type VI (black) - Never burn
The higher the type and the degree of pigmentation, the greater the risk of postinflammatory hyperpigmentation. However, persons who have minimal pigmentation or light skin can develop prolonged postoperative erythema but are less likely to develop the pigmentary sequelae.