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Scarring after accident. Will TCA peel or CO2 laser be effective? Will laser be safe for diabetics?

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Practicing since : 2006
Answered : 520 Questions
Dear Doctor,

Around 5-6 years back I had an accident and the skin in my left forearm was totally damaged and infected. The surgeon had to take out the skin and after 6 months of regular dressing, I got new skin but it was totally scarred. Last year in May 2010, I went for a cosmetic surgery and a Split Thickness Skin Graft (STSG) was done. Now after one year, the forearm has totally healed but the grafted skin is still quite dark and looks ugly. I am attaching the pictures of the forearm after one year of the skin graft.

Upon advice from my Doctor, I apply a mixture of 3% Hydroquinone Cream and 0.025% Retinoic Acid Cream, every alternate day in the night. I wash it off after 3 hours and in the morning after bath, I apply a sunscreen. It has lightened the skin a little but not much. As you can see from the pictures, the front part of the forearm has become very light but the back part is still quite dark.

Can you please suggest what can be done to make the hand look as close to normal as possible ?? I have been advised that I may see a dermatologist and go for a TCA peel. Will that be effective ?? Also, should I go for CO2 Laser treatment and will that help ?? I have heard of Fractional Laser Treatment been done in Delhi and Mumbai ( I live in Kolkata). Should I try that ?? I am a diabetic on Insulin, so I have heard that in diabetic patients the laser treatment might be risky and may darken the area more. Please advise.

Thanks & Best Regards.
Posted Tue, 1 May 2012 in Skin Hair and Nails
Answered by Dr. Gaurang Krishna 7 hours later

Thanks for posting this query.

Mind you, this is a good result after a major accident. Your surgeons have done a good job.

Coming onto the colour mismatch, it is very difficult to achieve it with medical or laser treatment.

Some scarring has to be accepted after such a major accident.

With Lasers the most we can achieve is a textural improvement. Colour change may bot be achieved and you are very right when you say that there is a risk of paradoxical darkening after laser treatment.

The same is true for TCA (Trichloroacetic Acid )peels too.

They may help in textural improvement but chances colour change is minimal.

My suggestion is to start using a mixture of retino A-0.05%, Hydroquinone 5%, and lobate cream..twice daily..and good amount of sunscreen 2-3 times in the daytime after consulting with your physician.

Use this for another 2 months. Lets see how much of lightening of colour we can achieve and then may be we may consider laser treatment..

Hope i have answered your query I will be available for follow up.
Above answer was peer-reviewed by
Follow-up: Scarring after accident. Will TCA peel or CO2 laser be effective? Will laser be safe for diabetics? 10 hours later
Thanx for the reply. Can you please suggest some brand names for the lobate cream and the hydroquinone 5% cream. Do I have to mix the 3 creams myself or is a ready combination available? If I mix them together, then in what proportion? All 3 creams in equaly amount?

Secondly, is there a chance of paradoxical darkening with these creams like laser treatment? Or are they 100 % safe?

Thank you.
Answered by Dr. Gaurang Krishna 14 hours later
Thanks for the follow up.

Mix these creams in equal proportions, a pre mixed formula is not available in the market.

There is hardly any risk of paradoxical darkening.

Wishing you good health.
Above answer was peer-reviewed by
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