Lasers in Medical Science

, Volume 34, Issue 6, pp 1125–1135 | Cite as

Persistent Pixel Stamping Marks: a novel complication of fractional CO2 laser in scar treatment

  • Samia M. Esmat
  • Mona R. E. Abdel-Halim
  • Heba I. GawdatEmail author
  • Marwa Kamel
  • Amany ElRamly
  • Kholoud Helmy
  • Soheir M. Esmat
Original Article


Fractional CO2 laser rejuvenation of scars offers a high safety profile. Laser marks usually disappear clinically within 1 week. The authors observed occasional persistence of the laser marks on the scar surface. The purpose of this study is to report the incidence and to describe the clinical, dermoscopic, and histological features of a novel observed complication of fractional CO2 laser scar rejuvenation “Persistent Pixel Stamping Marks (PPSM)”.One hundred seventy-one cases were consecutively recruited from patients assigned for fractional CO2 laser scar rejuvenation. Patients who developed the phenomenon 1 month post laser session were recorded and subjected to clinical photography, dermoscopy, and optical coherence tomography (OCT) as well as a 4-mm punch biopsy from pixelated scars. The evolution of PPSM was followed up for 6 months. PPSM developed in 16 patients (9.4%), 15 of which were post burn hypertrophic scars. PPSM was significantly related to darker skin type, darker scar color, and longer scar duration. Histopathological findings included characteristic holes in stratum corneum and superficial dermis, thick collagen bundles perpendicular to the skin surface with loss of elastic tissue, focal interface changes, and triangular focus of fibroblastic proliferation. The marks disappeared in 5 and lasted in 11 patients. Their longevity was significantly related to longer dwell times and lower densities. PPSM represent miniature scarring at the sites of the microscopic thermal zones or a sign of their delayed healing. They tend to follow fractional CO2 laser resurfacing of hyperpigmented, long-standing burn scars. Longer dwell times and lower densities make them last longer.


Persistent Pixel Stamping Marks Fractional CO2 laser Scars Complication 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  • Samia M. Esmat
    • 1
  • Mona R. E. Abdel-Halim
    • 1
  • Heba I. Gawdat
    • 1
    Email author
  • Marwa Kamel
    • 1
  • Amany ElRamly
    • 1
  • Kholoud Helmy
    • 1
  • Soheir M. Esmat
    • 2
  1. 1.Dermatology Department, Faculty of MedicineCairo UniversityCairoEgypt
  2. 2.Ophthalmology Department, Faculty of MedicineCairo UniversityCairoEgypt

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