ABSTRACT

Background: Laser resurfacing treatments have revolutionized dermatological procedures by improving skin texture, tone, and quality. Effective periprocedural care remains essential to reduce side effects, support healing, and optimize aesthetic outcomes. Hypochlorous acid (HOCl), a naturally occurring oxidant with anti-inflammatory and antimicrobial properties, has demonstrated efficacy in promoting wound healing and minimizing scarring.

Aim: To evaluate the use of stabilized HOCl mist in the periprocedural care of patients undergoing laser resurfacing.

Methods: Ten patients underwent treatment with UltraClear, CO2RE, and/or GentleMax Pro laser devices. Stabilized HOCl mist was applied before and after the procedure, with continued application twice daily for 1week posttreatment. Follow-up assessments at 1–3weeks and 1–3months post-procedure included clinical photography, tolerability evaluation, and aesthetic outcome assessment. Outcomes measured included Clinician Erythema Assessment (CEA), 4-point Edema Scale, Investigator Global Assessment of Pigmentation Scale (IPA), and Global Aesthetic Improvement Scale (GAIS). Statistical analysis was performed using the Friedman and Wilcoxon signed-rank tests.

Results: HOCl mist was associated with accelerated recovery, including a noticeable reduction in erythema and pigmentation. Statistically significant improvements were observed in CEA (p=0.007) and IPA (p=0.012) scores, indicating reduced clinical severity and pigment alteration. Edema and GAIS scores showed no statistically significant change.

Conclusion: Stabilized HOCl mist is well-tolerated and may significantly aid post-procedural recovery by minimizing side effects and reducing discomfort. Results support the potential role of stabilized HOCl mist as a beneficial adjunct in post-laser skincare, contributing to faster healing, reduced inflammation, and enhanced cosmetic results.

1 | Introduction

      Lasers are revolutionizing skin treatments by improving diverse health and aesthetic skin benefits and providing more effective and long-lasting results [1]. The UltraClear (Acclaro), CO2RE (Candela), and GentleMax Pro (Alexandrite, Candela) are highly effective for ablative resurfacing, targeting fine lines, wrinkles, and skin laxity while promoting collagen production, skin tone, textural irregularities and scars, photodamage, and improvement of overall skin quality [2–4]. The UltraClear is a 2910nm erbium laser that utilizes ultra-short pulse technology to deliver precise, controlled resurfacing with minimal thermal damage [2]. CO2RE is a 10 600nm fractional carbon dioxide laser that offers fractional ablative skin resurfacing to stimulate deep tissue remodeling and tightening [3]. The GentleMax Pro utilizes dual wavelengths (755nm Alexandrite and 1064nm Nd:YAG) toallow for precise and effective treatments on different skin types and various conditions [4]. In one study, the laser demonstrated efficacy in treating sun damage lentigines, showing improvement in skin photodamage, pigmentation, and overall skin radiance [4].

      In order to optimize the results and skin healing after these lasers, peri-procedure skincare regimens are crucial when utilizing these resurfacing lasers [5]. These include intensive skin moisturization, sun protection, and repair-promoting cosmeceuticals to reduce downtime and enhance cosmetic outcomes [6]. Proper post-procedure care accelerates recovery; minimizes side effects; and achieves healthier, brighter, smoother, firmer, and more youthful skin. As the popularity and efficacy of fractional resurfacing laser treatment for skin rejuvenation and acne scarring rise, there is a demand for ideal peri/post-procedure skin care to enhance healing and cosmesis [7]. Hypochlorous acid (HOCl), an oxidizing molecule produced naturally through the body's innate immune response, has recently gained momentum in dermatology applications for its antimicrobial, anti-inflammatory, and skin repair properties [8, 9]. Topically applied stabilized HOCl has demonstrated efficacy in creating an optimal wound-healing environment, potentially reducing scarring after laser procedures [8, 10]. Additionally, HOCl has been effective in treating the compromised skin of atopic dermatitis and associated pruritus, reducing itch and inflammation within 3days without adverse events [8, 9].

      In the context of post-laser care, HOCl has been incorporated into treatment regimens to enhance healing [11]. A review of post-laser topical agents highlighted the application of HOClcontaining sprays multiple times daily during the initial healing phase to support reepithelialization and reduce inflammation post ablative laser resurfacing procedure [12]. Furthermore, studies have shown that certain HOCl solutions increased the degree of reepithelialization by 14% compared with controlsolutions, indicating its potential to expedite skin wound healing [3, 8, 13]. Additionally, a review panel of leaders in dermatology and plastic surgery has recommended topical HOCl during all phases of injection or laser procedures, from preprocedure (removing excess makeup and disinfectant), through peri-procedure (spraying on the face cold packs) to long-term post-procedure (infection prevention and stimulating optimal healing) [14].

      Despite these promising findings, there remains a scarcity of evaluations examining the benefits of HOCl application periresurfacing laser procedures. This case series aims to assess the efficacy of peri-procedure HOCl skin mist in enhancing healing and cosmetic outcomes following treatment with combination and fractional lasers. In this case series, we present 10 patients who underwent a resurfacing laser procedure with peri-laser application of stabilized HOCl mist.

2 | Methods and Materials

      The study is a case series of 10 patients who underwent fractional UltraClear (Acclaro), CO2RE (Candela), or a combination with Alexandrite (Alex) (GentleMax Pro by Candela) laser procedures on their faces. Table 1 provides information about the patients' demographics, treatment plan, and treatment goal. The laser treatments were performed by a board-certified dermatologist in a dermatology clinic. Detailed inclusion/exclusion criteria were not implemented as this was designed as a retrospective case series rather than a prospective clinical study. Additionally, informed consent was obtained from all patients.

2.1 | HOCl Mist and Periprocedural Care

     Prior to the laser procedure, all participants had topical anesthetic preparation of compounded lidocaine 15% prilocaine/5% phenylephrine 0.5% for 1h. This was then removed with a 50/50 mix of alcohol and acetone solution. The HOCl mist used in this case series consists of stabilized 0.02% HOCl, formulated for skin resilience and homeostasis. HOCl mist was applied immediately prior to the laser procedure with gauze. Following the procedure, patients' faces were directly sprayed with HOCl, and they were instructed to spray their faces twice daily with HOCl spray for 1week following the laser procedure.

      The post-laser regimen also included twice daily application of occlusive biogel (Anteage), as-needed application of petrolatum based emollient, mineral-based sunscreen, and a gentle facial cleanser nightly for 1month post-procedure. Patients were also encouraged to use over-the-counter oral antihistamines as needed during their first week post-laser recovery. They were also guided to moisturize and protect their skin from sun exposure after the healing process for the most sustainable lase

2.2 | Post-Procedure Healing Follow-Up Visits

     Patients received one laser procedure visit followed by two follow-up visits, each consisting of post-laser photography (Figure 1) and a brief assessment of the tolerability and cosmetic benefits of the HOCl spray. The first follow-up visit was 1–3weeks postlaser, and the second follow-up visit was 1–3months post-laser.

2.3 | Pre and Post-Procedure Skin Assessment

     A board certified dermatologist and expert grader, who was blinded to the treatment protocol, specifically the laser procedures performed and the skincare product used, evaluated before and after facial images of each patient using the combined post-procedure skin assessment: Clinician Erythema Assessment (CEA), 4-point Edema Scale, Investigator Global Assessment of Pigmentation Scale (IPA), and Global Aesthetic Improvement Scale (GAIS) (AppendixS1).

2.4 | Data Analysis

     Following photo evaluation and completion of the combined post-procedure skin assessment, the Friedman test was employed to assess differences in CEA, Edema, and IPA scores across Pre-Treatment, Post-Treatment Visit 1, and PostTreatment Visit 2. To evaluate changes in GAIS score between Post-Treatment Visit 1 and Post-Treatment Visit 2, the Wilcoxon signed-rank test was utilized. No correction for multiple comparisons was applied.

3 | Results

     At the follow-up visits that occurred at weeks 1–3 post-laser treatment, patients reported expected skin redness, swelling, focal crusting, and exfoliation of the skin. These symptoms were resolved at the follow-up visit for all patients. Additionally, they reported that these symptoms lasted for approximately 5 days. All patients reported a good experience with using HOCl Mist, denying skin discomfort before laser treatment and denying worsening of skin redness, swelling, stinging, and burning sensation post-laser, as well as during the healing process. All patients reported feeling a more “calming or soothing” sensation with the use of HOCl mist as part of their post-care routine. The results revealed that the post-laser recovery treatment was well-tolerated, accelerated recovery, and minimized side effects.

     To evaluate changes in patient outcomes across treatment time points, we analyzed four variables: CEA Score, Edema Score, IPA Score, and GAIS Score, at Pre-Treatment, Post-Treatment Visit 1, and Post-Treatment Visit 2 (GAIS Score was assessed only at Post-Treatment Visits 1 and 2). Descriptive statistics, including median and interquartile range (IQR), were calculated for each variable at each time point. For variables measured at three time points (CEA, Edema, and IPA Scores), the Friedman test was used to assess differences across Pre-Treatment, PostTreatment Visit 1, and Post-Treatment Visit 2. For the GAIS

Score, differences between Post-Treatment Visit 1 and PostTreatment Visit 2 were evaluated using the Wilcoxon signedrank test. No correction for multiple comparisons was applied. Statistical significance was defined at p<0.05. Results are summarized in Table 2.

     CEA Score showed a significant change over time (Friedman statistic=9.879, p=0.007), with medians of 2.0 (IQR 1.5) at PreTreatment, 3.0 (IQR 0.8) at Post-Treatment Visit 1, and 1.0 (IQR 0.0) at Post-Treatment Visit 2. These results reflect the clinical trend: erythema increased post-treatment for most patients and subsequently resolved by the second follow-up. Edema Score did not show significant changes (Friedman statistic=4.786, p=0.091), with medians of 0.0 (IQR 1.0), 1.0 (IQR 1.8), and 0.5 (IQR 1.0) across the respective time points. Three patients demonstrated mild puffiness post-treatment; however, for the remaining patients, edema either increased post-treatment and improved by Visit 2 or was absent altogether throughout the post-treatment period. IPA Score exhibited a significant change (Friedman statistic=8.867, p=0.012), with medians of 2.5 (IQR 1.0), 2.0 (IQR 1.8), and 1.0 (IQR 0.8), supporting the observed trend of pigmentation reduction in nearly all patients by the final visit.

      GAIS Score showed no significant difference between PostTreatment Visits 1 and 2 (Wilcoxon statistic = 0.0, p = 0.062), with medians of 2.5 (IQR 2.5) and 4.0 (IQR 1.8), respectively. However, individual patient data revealed meaningful clinical improvement: 9 out of 10 patients showed an improved GAIS score by Visit 2, with several patients progressing from “worse” or “no change” at Visit 1 to “much improved” or “very much improved” by Visit 2. Only one patient did not display improvement. Despite these clinical trends, the lack of statistical significance should be interpreted as a limitation of the study. This may reflect not only the small sample size and subjective nature of GAIS but also the potential variability in patient-reported outcomes that limits the strength of these findings.

4 | Discussion

      Lasers are an important armamentarium in treating a variety of skin health and cosmetic concerns. Ablative and fractional laser resurfacing procedures have emerged as powerful tools in dermatology for improving a range of skin quality parameters, including tone, texture, tightness, and pigmentation irregularities [2–4]. As these technologies continue to evolve, so too does the importance of optimizing periprocedural care to enhance recovery and aesthetic outcomes. In this context, our case series highlights the potential benefits of incorporating stabilized hypochlorous acid (HOCl) mist into peri-laser regimens.

      HOCl's efficacy lies in its unique biochemical profile. As a naturally occurring oxidant produced by neutrophils, it exerts broadspectrum antimicrobial action without inducing cytotoxicity in host tissues [8, 9]. Furthermore, it modulates inflammatory cascades and promotes an optimal environment for wound healing [8, 10]. Importantly, the effectiveness of HOCl is formulation dependent, with parameters such as pH and concentration critical to ensuring stability and clinical utility [10, 14]. The formulation used in this study, 0.02% stabilized HOCl with neutral pH, meets the standards outlined in dermatologic literature for optimal efficacy and tolerability. This may account for the high patient satisfaction and absence of irritation or delayed healing observed in our case series.

      The results from our cohort of 10 patients suggest that the use of HOCl mist is not only well-tolerated but may also play a meaningful role in expediting post-procedural healing, reducing subjective discomfort, and minimizing common adverse effects such as erythema and edema. All patients reported subjective improvement in comfort during the immediate post-laser period, stating sensations of “soothing” and “calming” upon application of the mist. These findings are consistent with previously published literature that identifies HOCl's anti-inflammatory, antimicrobial, and wound healing capabilities as advantageous

in peri-laser settings [8–10].

      Quantitative analysis supports these observations as significant improvements were seen in both CEA and IPA scores over time, reflecting enhanced clinical outcomes and improved patientreported assessments of irritations and procedural aftereffects. Notably, CEA scores demonstrated a clinical pattern in which erythema increased after treatment for most patients before resolving by the second follow-up, suggesting a typical inflammatory response that was effectively controlled. While edema scores showed a nonsignificant trend toward improvement, this may reflect variability in individual inflammatory response.

     Three patients had mild puffiness post-treatment, whereas others either experienced edema that resolved by the second visit or had no measurable edema throughout the post-treatment period. Additionally, nearly all patients experienced an improvement in pigmentation over time, consistent with the significant changes in IPA scores. This supports the observed trend of pigmentation reduction in nearly all patients by the final visit. Although GAIS scores improved numerically from Visit 1 to Visit 2, the change did not reach statistical significance, potentially due to the small sample size or the subjective nature of aesthetic assessments.

      However, 9 out of 10 patients demonstrated improvement by the final follow-up, with several showing marked or very much improved scores, further reinforcing the favorable clinical trajectory observed. These findings highlight a positive clinical trend, even in the absence of statistical significance, indicating that patients had visible improvements in skin appearance and perceived cosmetic outcomes over time. Overall, the combination of positive patient-reported outcomes and statistically significant improvements in key clinical parameters highlights HOCl mist as a promising adjunct in peri-laser skincare protocols.

      Our observations also support the broader trend in procedural dermatology advocating for holistic peri-care regimens. Preprocedure preparation (including skin cleansing and antisepsis) and post-procedure maintenance (emollients, gentle cleansers, and photoprotection) are essential components in reducing complication rates such as infection and post-inflammatory hyperpigmentation, as well as contributing to skin repair and HOCl, with its multifunctional profile, integrates seamlessly into each phase of the skin recovery continuum, from pre-treatment cleansing and antisepsis to post-treatment inflammation, infection prevention, and wound healing support. According to Panossian, adaptogens are defined as innocuous agents that increase the state of nonspecific resistance to stress, enhance the body's ability to adapt to external stressors, and normalize via multiple physiological functions [15]. Based on this definition, and supported by Liu et  al., who identified and characterized agents with adaptogenic properties in dermatologic contexts, HOCl may be categorized as an active skin adaptogen [16]. Its nonhazardous nature, multimodal efficacy, and role in maintaining skin homeostasis further reinforce this classification. Evidence has demonstrated that skin adaptogens offer several normalizing advantages, such as enhancing resistance to stress, diminishing inflammation, improving skin repair physiology, and delaying premature aging [17]. Thus, as a skin adaptogen, HOCl possesses the ability to assist the skin's return to a healthier state of equilibrium after a laser procedure.

      Although the small sample size, short-term follow-up, and lack of a control group limit the generalizability of our findings, the uniform positive patient experiences and favorable healing observations provide a compelling foundation for further study. Additionally, a randomized, controlled trial comparing HOCl mist to placebo or alternative post-laser topical agents would be invaluable in identifying its true clinical advantage.

      This case series supports the adjunctive use of stabilized HOCl mist in the periprocedural management of laser procedures. With a favorable safety profile, ease of use, and multifaceted therapeutic action, HOCl mist represents a promising addition to the peri-laser skin care toolkit. Our initial results suggest that HOCl may contribute meaningfully to enhanced healing, reduced complications, and improved patient satisfaction following laser treatments.

Author Contributions

M.B.-K. and J.C. contributed to the drafting and editing of the manuscript. S.G. and I.V. contributed to the participants' data collection and entry. S.N. contributed to the data analysis, and J.R. performed the blinded photo evaluation. All authors have read and approved the final manuscript.

Acknowledgments

We would like to acknowledge all authors for their contribution to this research work.

Ethics Statement

We would like to extend gratitude to the patients participating in the study, who were treated in the most ethical way in accordance with Good Clinical Practices.

Consent

All the patients participating in the study agreed and signed the photo release consent for their photography for this publication.

Conflicts of Interest

Marianna Blyumin-Karasik, MD is a founder and CEO of Stamina Beauty LLC, manufacturer of HOCl mist.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Supporting Information

Additional supporting information can be found online in the Supporting Information section. Appendix S1: jocd70412-sup-0001- AppendixS1.pdf.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

© 2025 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

This article is excerpted from the 《Journal of Cosmetic Dermatology》 by Wound World.