SURGICAL

PEARL

Second-degree burns on skin marked for photoepilation: The need for white pencil use in cutaneous marking Sang Ju Lee, MD, PhD,a In Kwon Yeo, MD,b Kui Young Park, MD, PhD,b and Seong Jun Seo, MD, PhDb Seoul, South Korea

SURGICAL CHALLENGE Photoepilation uses the melanin contained in the hair follicle as a chromophore. The light beam heats the melanin, leading to selective photothermolysis in areas with a high melanin concentration, such as the hair follicle, with subsequent follicular unit destruction.1 Most side effects of photoepilation are minimal and transient, but skin burns are a possible complication of photoepilation because of heating of the chromophores.

SOLUTION A 33-year-old man who received photoepilation to both periareolar areas 2 months earlier presented with ring-shaped hypertrophic scarring (Fig 1). Erythematous patches and bullae developed soon after epilation with treatment with an intense pulsed light device. He reported that the lesions were consistent with the areas marked with black pen as part of the photoepilation procedure. We treated these areas with 5 treatments of 595-nm pulsed light laser and intralesional triamcinolone injection.

Fig 1. Annular-shaped erythematous hypertrophic scars on both periareolar areas 1 month after intense pulsed light epilation.

Many physicians use marking pens to help accurately demarcate areas subjected to aesthetic treatments. However, it should be remembered that black ink has an absorption spectrum similar to melanin. Excessive energy absorbed in the black penemarked area could lead to burns because of increased chromophore levels. To avoid such complications, a white pencil should be used for marking. A white eyebrow pencil is soft and convenient for variable aesthetic procedures, such as photoepilation, laser treatment, and filler injection. REFERENCE 1. Ibrahimi OA, Avram MM, Hanke CW, Kilmer SL, Anderson RR. Laser hair removal. Dermatol Ther 2011;24:94-107.

From the Yonsei Star Skin and Laser Clinic,a Seoul, and the Department of Dermatology,b Chung-Ang University College of Medicine, Seoul. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Kui Young Park, MD, PhD, Department of Dermatology, Chung Ang University Hospital, 224-1

Heukseok-dong, Dongjak-ku, Seoul 156-755, South Korea. E-mail: [email protected]. J Am Acad Dermatol 2014;71:e13. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.02.016

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Second-degree burns on skin marked for photoepilation: the need for white pencil use in cutaneous marking.

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