Prophylaxis for and treatment of uncomplicated skin and skin structure infections in laser and cosmetic surgery

Abstract

Complications of laser resurfacing include infections, scarring, hyperpigmentation, hypopigmentation, and delayed healing. Postoperative infections cause pain, prolonged healing, and can result in scarring. Ablative laser techniques cause partial- or full-thickness wounds, whereas so-called "nonablative procedures" may cause "spotty" epidermal wounds. Antibiotic prophylaxis is necessary when the risk for postoperative infection is significant or when the risk of infection is moderate but the consequences of infection are significant. Prophylactic antibiotic agents should have a broad spectrum of activity, be well-tolerated and be safe. The most appropriate choice is a broad-spectrum agent such as cefdinir, even for patients allergic to penicillin. Additionally, all patients should be treated prospectively with antivirals to prevent activation and dissemination of herpes simplex virus type I. Treatment of infections in patients who have and have not received prophylactic antibiotics requires identification of the causative factor and appropriate treatment. Nonablative treatments such as photodynamic therapy do not usually require antibiotic prophylaxis, although a few patients treated for acne may acquire a secondary bacterial infection that should be treated.