Hyperpigmentation after sclerotherapy: own experience in therapeutic Q-switched Nd:YAG laser treatment

Introduction:
Hyperpigmentation as a common side effect of sclerotherapy requires long and difficult treatment. Its prevention includes repeated thrombectomy. Therapeutic options include the use of topical bleaching agents, iron chelating agents, deep medical peels, oral sulodexide administration or repeated treatments with Q-switched nano- or picosecond lasers. The aim of this case study is to present our own experience with the use of a 1064 nm/532 nm Q-switched Nd:YAG laser for post-procedural hyperpigmentation treatment.

Material and methods:
Seven women aged 36-67 years who developed hyperpigmentation after foam sclerotherapy were evaluated. After sclerotherapy and hyperpigmentation occurrence all patients underwent local thrombectomy. The next stage consisted of 2-4 sessions of ablation with a 532 nm laser in Q-switched mode. Duplex Doppler ultrasound was performed in all patients to exclude the reflux potentially related to the occurrence of hyperpigmentation.

Results:
The laser treatment showed a significant improvement in the appearance of skin lesions. Skin whitening occurred in 6 patients (86%). In 1 patient no change in the skin hyperpigmentation was observed during the 6-month follow-up, and 1 patient manifested skin depigmentation after treatment. No abnormality in the superficial vein system in the treated area was found in the study group owing to the previous foam sclerotherapy being performed correctly. The veins had been resorbed, leaving deposits of pigments in the subcutaneous tissue.

Conclusions:
Sclerotherapy has the side effect of hyperpigmentation along the treated veins, which can be successfully treated with a 1064 nm/532 nm Q-switched Nd:YAG laser.