One of the main reasons for the popularity of microdermabrasion is its safety. The main risk of any surface abrasion is pigmentary disruption. Lasers, intense pulsed light devices, as well as microdermabrasion are often utilized to treat sun-induced hyperpigmentation, melasma, and PIH, yet practicing physicians are well aware of the risk of inducing PIH from these procedures, especially in darker skin types. Indeed, one of the first published reports on the use of microdermabrasion did report PIH [15]. For this reason, the concurrent use of sunscreens is advisable to all patients. The risk of infection, though minimal, has been cautioned in the literature [31]. As with all equipment, precautions against cross contamination and spread of infection must be exercised. The mechanical friction on the skin could result in histamine release and an urticarial response [32]. Concerns regarding both foreign body granuloma and eye irritations have been voiced [20]. Certainly, a recent trend has been away from the particulate form of microdermabrasion and toward the particle-free technology using abrasive paddles and hand pieces because of these issues. In addition, aerosolization of particles into the lungs is a concern, but one that seems to be avoidable with the proper use of masks by the technicians utilizing the machines on a daily basis. The slight risk of petechiae and purpura from suction should be considered, and prolonged dwell time needs to be avoided. Combining peels and microdermabrasion, especially by inexperienced technicians, can result in complications (Fig. 14.2).
The supervising physician should pay attention to the baseline condition of patients. Active infections such as flat warts, herpes simplex, molluscum contagiosum, or any possible bacterial infection such as staphylococcus aureus are all absolute contraindications to treatment. Some have suggested that rosacea and telangiectasias, as well as active pustular acne are relative contraindications [8]. This is probably good thinking, especially since laser and light treatments give superior results for these diagnoses anyway. All patients on retinoids should be treated with caution.