Insulin Resistance as a Potential Predictor of Post-Inflammatory Hyperpigmentation After CO2 Laser Resurfacing: A Real-World Study of a Dual Technique Protocol (Maghreb Experience)

Purpose

Laser-assisted skin regeneration is a cornerstone of modern dermatologic practice; however, post-inflammatory hyperpigmentation (PIH) remains a major limiting complication of CO 2 laser treatments. Risk has traditionally been attributed to darker phototypes, particularly in high ultraviolet (UV) exposure settings. Emerging evidence suggests that metabolic factors, especially insulin resistance measured by HOMA-IR, may influence pigmentary responses. This study evaluated a Dual Technique CO 2 laser protocol designed to enhance skin regeneration while reducing the number of treatment sessions and explored the association between PIH and metabolic status. Patients and Methods: A prospective, non-randomized, real-world study included 45 patients treated in a private practice in the Maghreb region, characterized by high UV exposure and predominantly medium-to-high phototypes. The Dual Technique combined ablative fractional vaporization with subablative thermal stimulation. Skin quality was assessed using the Vancouver Scar Scale (VSS), and PIH severity using the Dermal Pigmentation Area and Severity Index (DPASI). Outcomes were analyzed in relation to phototype, HOMA-IR, and polycystic ovary syndrome (PCOS).