Sequential low-fluence Q-switched neodymium-doped:yttrium aluminum garnet and fractional CO 2 laser therapy in lichen planus pigmentosus: A case report

Lichen planus pigmentosus (LPP) is a chronic pigmentary disorder characterized by slate-gray to dark brown macules and patches, predominantly affecting photo-exposed areas. Management remains challenging, as conventional medical therapies often result in partial or temporary improvement. We report a case of a 37-year-old female with long-standing, stable LPP who was managed using a sequential combination of low-fluence Q-switched neodymium-doped: yttrium aluminum garnet laser and fractional CO 2 laser, along with adjunctive topical therapy and strict photoprotection. Significant clinical improvement in pigmentation and texture was observed over a 5-month period without adverse effects. This case highlights the potential role of a sequential laser approach in recalcitrant LPP following disease stabilization.