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Case Reports
. 2025 Apr 16;17(4):e82375.
doi: 10.7759/cureus.82375. eCollection 2025 Apr.

Combined Laser Therapy for Post-sclerotherapy Hyperpigmentation Following Nicolau Syndrome: A Case Report

Nikolai Alekseev  1 , Valeriia Mishanina  2
Affiliations
Case Reports

Combined Laser Therapy for Post-sclerotherapy Hyperpigmentation Following Nicolau Syndrome: A Case Report

Nikolai Alekseev et al. Cureus. .

Abstract

Post-sclerotherapy hyperpigmentation is a common adverse effect, particularly when complicated by Nicolau syndrome, a rare injection-related event that can lead to tissue necrosis and persistent pigmentary changes. We report a case of a 40-year-old woman with Fitzpatrick skin type II, who developed longstanding hyperpigmentation in the right popliteal area following polidocanol sclerotherapy. Clinical and dermoscopic examination revealed mixed melanin and hemosiderin deposition. The patient was successfully treated using a quadrant-specific multimodal laser approach combining intense pulsed light (IPL), Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG), and erbium-doped yttrium aluminum garnet (Er:YAG) lasers over two sessions. Notable pigment clearance, full crust exfoliation, and restoration of normal skin tone were achieved without adverse effects. Independent expert evaluation and patient-reported outcomes confirmed the treatment's efficacy and high tolerability.

Keywords: er:yag; ipl; laser therapy; nicolau syndrome; post-sclerotherapy hyperpigmentation; q-switched nd:yag.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Clinical evolution of the lesion in the early post-sclerotherapy period. The initial presentation (a) shows a violaceous discoloration with irregular borders localized to the right popliteal region, consistent with post-injection vascular injury. During clinical evaluation (b), topical treatment was initiated without complications. Follow-up examination (c) revealed early signs of improvement, with a visible reduction in pigmentation and lesion size.
Figure 2
Figure 2. Clinical appearance of the lesion before laser treatment, showing irregular, heterogeneous hyperpigmentation. Dermoscopy revealed superficial and deep pigment deposits consistent with melanin and hemosiderin.
Figure 3
Figure 3. Quadrant-specific laser treatment approach showing distribution of IPL, Q-switched Nd:YAG, and Er:YAG modalities across the lesion.
IPL: intense pulsed light; Nd:YAG: neodymium-doped yttrium aluminum garnet laser; Er:YAG: erbium-doped yttrium aluminum garnet laser.
Figure 4
Figure 4. Evolution of the lesion following the first laser session. (a) Initial darkening observed across all quadrants, with partial sparing in the upper-right quadrant due to uneven stencil application. (b) Increased pigmentation with thin crust formation, particularly in IPL-treated areas. (c) Marked lightening in the lower-right quadrant following exfoliation. (d) Partial pigment clearance in the upper-right quadrant.
IPL: intense pulsed light.
Figure 5
Figure 5. Clinical evolution following the second laser session. (a) Immediate post-procedure appearance with mild erythema and laser grid marks. (b) Progressive pigment breakdown noted across all quadrants. (c) Pronounced exfoliation and significant lightening observed. (d) Marked pigment reduction and near-complete clearing of the lesion.
Figure 6
Figure 6. Pre- and post-treatment comparison. (a) Baseline hyperpigmentation. (b) Near-complete pigment clearance after treatment.
See this image and copyright information in PMC

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References

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