LAUSR

reaction; there was no mention of mediator blockage in this case. The risk of iatrogenic mast cell degranulation is likely dictated by the density of mast cells in each lesion. Our patient had a negative Darier sign, possibly suggesting a limited burden of mast cells in each lesion and/or decreased sensitivity to degranulation secondary to physical trauma. The need for antihistamine blockade before, during, or following treatment should be determined on a case-by-case basis. We advise counseling all patients on potential symptoms related to laser inducedmast cell degranulation. In caseswith apositiveDarier sign, the benefits of administering antihistamines (or at least having these medications readily available) may outweigh the marginal risks of this class of medications.