CO2 laser resurfacing can remove freckles and prevent or postpone malignancies in patients with xeroderma pigmentosum

Background: There is no cure for xeroderma pigmentosum (XP) patients who suffer from persistent freckling and recurrent lifethreatening malignancies. We aimed to remove facial lentiginous pigmentations using CO2 laser resurfacing. Methods: 5 patients with clinically proven XP living in their third decade were scheduled to be treated with CO2 laser resurfacing. After tumescent anesthesia, the whole facial skin was treated with 3 UltraPulse® conventional CO2 ablation passes. The parameters used were 6 mJ, 5 mJ, and 4 mJ for the first to third passes. The mandibular areas were treated with two passes of 4 and 3.2 mJ, while the eye contours were treated with two passes of 3.6 mJ and 3.2 mJ. Results: The face was edematous and almost free of freckling immediately after resurfacing. The edema persisted for a week. The facial skin oozed within the first three days, followed by crust formation. After a week and after complete shedding of the crusts, smooth and erythematous skin appeared. The erythema persisted for more than two months. The patients were free of malignancy and freckling for up to 16 months follow-up. Conclusion: CO2 laser can remove lentiginous pigmentation and prevent or postpone malignancies for a considerable length of time.