Lichen planus pigmentosus successfully treated with conventional CO2 laser resurfacing

Lichen planus pigmentosus (LPP) develops as an asymptomatic and dusky pigmentation of the facial skin with no effective treatment. Herein we report a 54-year-old lady with clinical and histopathologic confirmation of LPP who was scheduled to be treated with CO2 laser resurfacing. After tumescent anesthesia, the whole facial skin was treated with three passes of Ultrapulse conventional CO2 ablation. The energy used in the first, second, and third passes were 6.6, 5.4, and 4.8 mJ, respectively. The mandibular area was treated with two passes (4.2 and 3.6 mJ). The eye contours were treated with two passes (3.9 and 3.3 mJ). The patient’s face remained edematous for a week, with the facial skin oozing within the first three days before it became crusted. The crust shed out from day three to six. After a week, smooth and erythematous skin appeared. The erythema persisted for up to four months, after which uniform skin with considerable bleaching and rejuvenation developed. No recurrence occurred within 18 months of follow-up. We conclude that LPP can be treated with CO2 laser resurfacing without any complications.