Treatment of adenoma sebaceum by cryosurgery. Report of a case

Efficacy of pulsed dye laser in cosmetically distressing facial dermatoses in skin types IV and V

BACKGROUND

Pulsed dye laser (PDL) has revolutionized treatment of vascular dermatoses. It has been successfully employed to treat several non-vascular conditions in fair skinned individuals without producing significant pigmentary and textural complications.

AIM

A preliminary study was undertaken to assess its efficacy in cosmetically distressing facial, vascular and non-vascular dermatoses in Indian patients with skin types IV and V.

MATERIALS AND METHODS

Nine patients of ages 7 to 55 years, with facial verruca plana (VP- 4 cases), angiofibromas (AF- 4 cases) and multiple pyogenic granulomas (PG- one case) were recruited. They had no systemic complaints. Laser parameters used were (spot size/fluence/wavelength/pulse duration):VP- 5mm/5.5-7.5J/585nm/0.45ms; AF-5mm/6-8.5J/585nm/0.45ms;PG- 5mm/7J/585 and 595nm alternately/1.5ms. Response was assessed clinically and photographically.

RESULTS AND CONCLUSIONS

All VP lesions completely resolved after 2-4 sessions (mean 3.25 sessions), AF showed 50% regression in all cases after 2-3 sessions (mean 2.5 sessions) and > or =75% subsidence after 3-7 sessions (mean 5.5 sessions) and in PG, after 3 sessions, there was complete subsidence of small satellite lesions with moderate shrinkage of larger papules and complete resolution after 5 sessions. Complications included transient hyperpigmentation/hypopigmentation only. There was no recurrence during next 6 months. PDL offers significant cosmetic improvement in facial dermatoses in Indian patients.

Extensive facial adenoma sebaceum: successful treatment with mechanical dermabrasion: case report

This report documents the successful elimination of disfiguring sebaceous adenomas from the face of a 21-year-old male patient with mechanical dermabrasion.

Carbon dioxide and pulsed dye laser treatment of angiofibromas in 29 patients with tuberous sclerosis

BACKGROUND

Data on the benefits, adverse effects and appropriate types of laser treatment for angiofibromas (AF) in patients with tuberous sclerosis (TS) are limited.

OBJECTIVES

To evaluate the efficacy and side-effect profile of carbon dioxide (CO2) 10,600 nm wavelength and flashlamp-pumped pulsed dye (FLPDL) 585 nm wavelength lasers in a retrospective study of 29 patients with TS aged 9-48 years.

METHODS

Long-term results, based on clinical improvement of the vascular, fibrous or protuberant types of AF and the presence or absence of side-effects on follow-up visits, were classified as excellent, moderate or poor.

RESULTS

Results were excellent in most patients with vascular-type AF treated with one or two sessions of FLPDL, but some required up to six treatment sessions. CO2 lasers produced excellent results with considerable long-term improvement in 10 of 13 (77%) patients with fibrous or protuberant AF, specifically in all (three of three) protuberant and 70% (seven of 10) of fibrous AF. Persistent hypertrophic scarring was seen in three of 13 (23%) patients with either fibrous or protuberant AF treated with the continuous wavelength CO2 laser. Treatment with both lasers used in four patients with combined vascular and non-vascular AF components was excellent in three of four (75%) patients. Significant relapse was seen in one patient treated with the CO2 laser.

CONCLUSIONS

CO2 or FLPDL laser treatment should be considered as an effective treatment for patients with disfiguring TS. A combination of lasers may be required to achieve optimal results.

Treatment of adenoma sebaceum with the copper vapor laser

BACKGROUND

Angiofibromas of the central part of the face (adenoma sebaceum) occur pathognomonically in tuberous sclerosis, causing significant cosmetic and hygienic morbidity. Treatment has included excision, dermabrasion, cryosurgery, carbon dioxide laser, and argon laser. Copper vapor lasers emit light at 511 nm (green) ad 578 nm (yellow), useful for treating pigmented and vascular lesions, respectively.

OBJECTIVE

Because of the vascular nature and progressive pigmentation of adenoma sebaceum, we examined the utility of the copper vapor laser in treating this disorder.

METHODS

Nine patients with adenoma sebaceum were treated with the copper vapor laser. Individual lesions were treated with the yellow light (578 nm) at 0.4 to 0.6 mW. Pigmented lesions or lesions resistant to treatment were treated with the green light (511 nm) at 0.4 to 0.9 mW. Intervals between treatments were at least 6 weeks.

RESULTS

Good to excellent cosmetic results were seen in all treated patients. Scarring or hyperpigmentation occurred in none of the patients. Most patients required additional treatments with the copper vapor laser as new lesions developed.

CONCLUSION

The copper vapor laser is safe and effective for the treatment of adenoma sebaceum in tuberous slerosis.

CO2, argon, and pulsed dye laser treatment of angiofibromas

BACKGROUND

Tuberous sclerosis is a complex disorder of hamartoma formation in many organs, particularly the skin, brain, eye, kidney, and heart. The characteristic skin lesions are angiofibromas (AF), the shagreen patch, periungual fibromas, and "ash-leaf" white macules. Treatment for AF has previously included electrocoagulation, electrodesiccation and curettage, dermabrasion, excision, cryosurgery, and oral 13-cis retinoic acid. Both argon and CO2 lasers have been used in isolated cases to treat AF.

OBJECTIVE

The purpose of this work is the study of the application of three different lasers in the treatment of facial AF.

METHODS

Ten patients with facial AF were treated with CO2, argon, and pulsed dye lasers. Patients' AF were graded with regard to the size and color of the lesions. A 2-3-cm2 test was assayed on the face of all patients with each laser before performing a complete treatment and in order to choose the best laser.

RESULTS

Results were considered excellent in seven patients and good in three patients, with decrease of erythema and flattening of the AF. Minimal scarring was noted in two patients. Transient erythema was observed in patients treated with the CO2 laser. All patients or their parents considered the treatment cosmetically satisfactory.

CONCLUSION

We found the CO2 laser to be a better therapeutic tool than the argon laser to treat AF, especially in those patients with multiple and protuberant AF. The argon laser would be more useful in those patients with very red AF and light complexion, and the pulsed dye laser in those with very red and flat AF.

Cryosurgery updated

Cryosurgery is an effective modality for treatment of many benign, premalignant, and malignant cutaneous lesions. New indications for benign lesions, new data, and recent trends towards more aggressive treatment of malignant lesions are mentioned. The differences in management between benign and malignant lesions are addressed. This article discusses cryobiology, equipment, advantages of cryosurgery, techniques of treatment, tissue response, results, complications, and contraindications.

Angiofibromas in tuberous sclerosis: comparison of treatment by carbon dioxide and argon laser

Multiple angiofibromas (adenoma sebaceum) of the nose in a dark-complexioned patient with tuberous sclerosis were treated with laser surgery. One side of the nose was treated with the argon laser. The other side of the nose was treated with the carbon dioxide (CO2) laser. The CO2 laser produced superior cosmetic results with more complete removal of cutaneous lesions.

Management of facial angiofibromas in tuberous sclerosis: use of the carbon dioxide laser

Facial angiofibromas are estimated to occur in 90% of patients with tuberous sclerosis and can cause considerable cosmetic disfigurement, emotional distress, obstruction of vision, and hemorrhage when abraded. Postoperative wound management associated with skin grafting and dermabrasion is often difficult because patients are mentally retarded and noncooperative. Three patients with extensive facial angiofibromas were treated successfully with the carbon dioxide (CO2) laser, with follow-up period ranging from 8 to 48 months. Uncomplicated wound healing occurred in each patient with minimal recurrence of lesions. Ablation with the CO2 laser is our treatment of choice for angiofibromas associated with tuberous sclerosis.