Service: Fotona SP Dynamis (Er:YAG 2940 nm / Nd:YAG 1064 nm) & StarWalker MaQX (QS 1064/532 nm ± dye 585/650 nm).

Cause / Mechanism

Laser procedures disrupt the skin barrier and adnexal structures, creating a portal for microbial invasion. Risk is higher with ablative resurfacing (Er:YAG), large treatment fields, occlusive dressings, or inadequate asepsis. Common organisms: Staphylococcus aureus (incl. MRSA), Streptococcus spp., Malassezia/Candida in moist folds; viral reactivation (HSV-1) peri-orally (see dedicated HSV protocol). ^{1 2 3}

Risk Factors

• Patient: diabetes, immunosuppression, atopic dermatitis, history of recurrent skin infections, active dermatitis, recent antibiotics.
• Procedure: ablative resurfacing, prolonged treatments, peri-oral/peri-nasal areas, large fields, occlusive dressings.
• Operator/Environment: breaks in aseptic technique, inadequate hand hygiene, contaminated consumables, poor room cleaning, shared cosmetics. ^{1 2 4}

Signs & Symptoms

• Bacterial cellulitis/impetiginisation: spreading erythema, warmth, pain, purulence/crusting, fever, lymphangitis.
• Folliculitis/acneiform eruption: perifollicular papules/pustules, tenderness/itch.
• Fungal intertrigo: erythematous macerated plaques with satellite pustules in folds.
• Viral: grouped vesicles on erythematous base (HSV); dermatomal vesicles with pain (VZV—rare). ^{5 6 7}

Prevention

• Standard & transmission-based precautions; 5 moments of hand hygiene. ¹
• Pre-procedure skin cleansing (non-flammable antiseptic); allow complete drying. ^{1 2}
• Aseptic technique for ablative procedures/dressings; single-use consumables; no double-dipping. ¹
• Device & room decontamination per manufacturer and local policy; log cleaning between patients. ^{2 4}
• Patient education: clean pillowcases/towels, avoid makeup/occlusion until re-epithelialised; strict sun protection.
• Screen for cold sores; use HSV prophylaxis where indicated (see HSV protocol). ⁸

Management Protocol

A) Bacterial Cellulitis / Impetiginisation

• Mark borders; assess for systemic features (fever, tachycardia) and red flags (orbit/hand/genital involvement, rapidly progressive pain). ⁵
• Swab if purulent or recurrent; consider MRSA risk. ⁵
• Start empiric antibiotics per local guidelines; adjust to swab. Provide analgesia and limb elevation if applicable. ^{5 9}
• Review 24–48 h. Escalate to ED if systemic toxicity, rapidly progressive spread, or failure of therapy.

B) Folliculitis / Acneiform Eruption

• Gentle cleansing; avoid occlusive products; consider antiseptic washes.
• Topical agents (e.g., benzoyl peroxide or antibiotic/antiseptic per local protocols). ⁶
• Culture if severe or recurrent to exclude Gram-negative/MRSA.
• Consider dermatology referral if persistent.

C) Fungal Intertrigo / Candida

• Keep area dry; reduce friction; non-occlusive dressings.
• Topical azole antifungal; consider short course oral therapy if extensive or refractory (evaluate interactions/contraindications). ⁷
• Review hygiene and clothing; address hyperhidrosis if contributing.

D) Viral Reactivation or Infection

• HSV-1: see dedicated HSV-1 Reactivation Fact Sheet for prophylaxis and treatment. ⁸
• Suspected VZV: urgent GP/dermatology/ID review; commence antivirals per guidelines and institute contact/droplet precautions if indicated.

Follow-up & Documentation

• Document onset, site, severity, vitals, and treatment plan; photograph when appropriate.
• Provide written aftercare and red flags; schedule review in 24–72 h depending on severity.
• Record in Laser Log; complete incident form for moderate–severe infections.
• Audit compliance with hand hygiene/aseptic technique; reinforce training if breaches identified. ^{1 2}

Sources

1. Australian Commission on Safety and Quality in Health Care (2023). Australian Guidelines for the Prevention and Control of Infection in Healthcare., viewed 7 October 2025, https://www.safetyandquality.gov.au/publications-and-resources/resource-library/australian-guidelines-prevention-and-control-infection-healthcare ↩︎
2. ACSQHC. Infection Prevention and Control resources (Standard & Transmission-based precautions)., viewed 7 October 2025, https://www.safetyandquality.gov.au/our-work/infection-prevention-and-control ↩︎
3. NSW Health. Infection prevention policy framework and resources., viewed 7 October 2025, https://www.health.nsw.gov.au ↩︎
4. Queensland Health. Infection prevention & control guidelines and links., viewed 7 October 2025, https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/infection-prevention/queensland-infection-prevention-and-control-guidelines-and-resources/australian-guidelines-and-links ↩︎
5. healthdirect (Australian Government). Cellulitis — consumer clinical guidance., viewed 7 October 2025, https://www.healthdirect.gov.au/cellulitis ↩︎
6. DermNet NZ. Folliculitis overview and management., viewed 7 October 2025, https://dermnetnz.org/topics/folliculitis ↩︎
7. DermNet NZ. Candida intertrigo., viewed 7 October 2025, https://dermnetnz.org/topics/candidal-intertrigo ↩︎
8. Melbourne Sexual Health Centre / ASHM. HSV guidelines (see HSV fact sheet for details)., viewed 7 October 2025, https://sti.guidelines.org.au/sexually-transmissible-infections/genital-herpes-simplex-virus-hsv/ ↩︎
9. Therapeutic Guidelines (eTG). Antibiotic: cellulitis/skin and soft tissue infections (subscription site)., viewed 7 October 2025, https://www.tg.org.au ↩︎