A 3-year-old girl with incontinentia pigmenti was referred for treatment of pigmented whorled macules on the trunk and limbs. Initially ruby laser therapy was only given to the legs. Wound healing was delayed. Two months later the patient developed extensive vesicles and erosions restricted to pigmented macules in both treated and untreated areas. Conservative treatment, including 2 weeks hospitalization, improved acute inflammation, but the remaining pigmentation was darker than originally seen. The apparent reappearance of an early cutaneous manifestation of this syndrome, seemingly triggered by laser therapy, would suggest such treatment is contraindicated.
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