What is the best topical ointment to apply to the skin after fractional (fraxel) laser treatment?

Post-Fraxel Laser Treatment: Topical Management

Apply plain petrolatum (white petroleum jelly) or a bland, fragrance-free emollient immediately after fractional laser treatment—avoid topical antibiotics like neomycin or triple antibiotic ointment due to high rates of allergic contact dermatitis without proven benefit for these controlled wounds.

Recommended Post-Procedure Wound Care

Primary Treatment Approach

• Use plain petrolatum (white petroleum jelly) as the first-line topical agent after Fraxel laser treatment 1, 2
• Petrolatum provides equivalent wound healing efficacy compared to antibiotic ointments for superficial procedural wounds 2
• Apply twice daily to the treated area until re-epithelialization is complete 2

Alternative Non-Antibiotic Options

• Bland, fragrance-free moisturizers or emollients can be used if petrolatum is not tolerated 3
• Hyaluronic acid cream may provide symptomatic relief for post-procedure skin 3
• These should be applied after the procedure, not immediately before any subsequent treatments 3

Critical Agents to Avoid

Topical Antibiotics Should Be Avoided

• Neomycin-containing products have an 11% rate of allergic contact dermatitis in the general population and 5.3% in post-surgical patients 1, 4
• Bacitracin causes allergic contact dermatitis in 8% of patch-tested patients and 2% of post-surgical patients 1, 4
• The risk of allergic contact dermatitis from topical antibiotics (1.6-2.3%) equals or exceeds the risk of post-procedural infection (1-2%) in dermatologic procedures 1
• Triple antibiotic ointment (neomycin/polymyxin B/bacitracin) should be avoided despite its antimicrobial efficacy, due to the neomycin component's high allergenicity 1, 4, 5

Other Products to Avoid

• Fragranced products, perfumes, or alcohol-based lotions can irritate healing skin 3
• Antiseptic creams should not be overused as they can cause skin irritation 3
• Deodorants on or near treated areas 3

General Wound Care Principles

Hygiene and Cleaning

• Keep the treated area clean and gently dry between applications 3
• Use a gentle cleanser and pat dry with a soft, clean towel 6
• Clean the area shortly before any subsequent laser sessions if applicable 3

Sun Protection

• Avoid sun exposure to treated areas using soft clothing coverage and/or mineral-based sunblocks 3
• This is critical during the healing phase and for several weeks post-procedure 3

Physical Precautions

• Do not scratch the treated area even if itching occurs 3
• Avoid trauma or abrasion to healing skin 3

When Antibiotics Might Be Considered

Limited Indications

• If clinical signs of infection develop (progressive edema, persistent warmth, purulent drainage, lymphangitis), topical antibiotics without neomycin may be considered 3, 6
• Mupirocin is not a significant allergen and could be used if infection is suspected 1, 5
• Polymyxin B alone (without neomycin) is also not a significant allergen 1, 5
• However, prophylactic topical antibiotics are not recommended for clean procedural wounds 3, 7

Important Caveat

• The evidence supporting topical antibiotics for reducing surgical site infections applies primarily to surgical wounds, not cosmetic laser procedures 7
• Fractional laser creates controlled micro-injuries in a sterile environment, making infection risk extremely low 1, 2
• The harm from allergic contact dermatitis likely outweighs any theoretical infection prevention benefit in this setting 1, 4, 2

Monitoring and Follow-Up

• Assess the treated area for signs of infection including increased warmth, swelling, purulent drainage, or systemic symptoms 6
• If allergic contact dermatitis develops (new rash, itching, burning beyond expected post-procedure symptoms), discontinue all topical products except plain petrolatum 1, 4, 2
• Expected post-procedure erythema and mild burning are normal and should resolve progressively 6, 2