Luke's Tuberous Sclerosis Page
Dermatological Research |
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CARBON DIOXIDE AND PULSED DYETREATMENT OF ANGIOFIBROMAS E Papadavid, GBellaney, NPJ Walker, Lister Hospital, London & Churchill Hospital,Oxford Patients with tuberous sclerosis (TSC) may present with the characteristic skin lesion angiofibromas (AF), shagreen patches, periungual fibromas and ash-leaf white macules in 60% of the cases. Often these skin lesions may be the only evidence of the syndrome AF appears between 4 and 10 years of age in a centro facial distribution and may continue to develop for many years. They may be mild and mistaken for acne papules or cause a severe facial disfigurement. Histology shows hyperplastic blood vessels and dermal fibrosis. Apart from electrocoagulation, electrodesiccation and curettage, dermabrasion, cryosurgery or excision, different lasers have been used to treat AF with success. The purpose of this retrospective study is to evaluate carbon dioxide (CO2) 10600nm and Flash-lamp Pulsed Dye Laser (FLPDL) 585nm in the treatment official AF in 29 TSC patients between 9- 41 years old. A -3cm2test was assayed on the face of the patients before the complete treatment. The full procedure was usually performed under general anaesthesia. Thirteen patients with protuberant AF were selected for CO2 treatment, 12 patients with mainly red AF for FLPDL with electrosurgery used in some of the patients with papular lesions, and 4patients were treated using the combination of CO2 and FLPDL. FLPDL was used at densities ranging between 6.5 - 8.5J/cm2 with a 5-7 nm spot size and CO2 continuous wave or superpulse at different energies and number of passes dependant on the thickness of the AF. Results were considered excellent in the majority of the patients treated with 1-2 sessions of FLPDL, but some required up to 6 treatment sessions. Some of these patients (3) may require and additional CO2 treatment to achieve 100% overall improvement. The CO2laser had excellent results in protuberant AF but hypertrophic scarring was an adverse reaction seen in 7 cases (1 patient withdrew) and hyperpigmentation in 1 patient treated with the continuous wave CO2 laser. Relapse was only seen in 1 patient treated with CO2. Hypertrophic scarring was treated with intra lesional steroids with considerable improvement in all patients, being a long-term problem only in3 out of 13 patients. Combined treatment with both lasers was considered in 4 patients because of the presence of protuberant and vascular AF in different anatomical units of the face and the overall improvement was excellent in 75% of the cases. We consider laser treatment effective in the treatment of AF. FLPDL is very effective in the treatment of mainly vascular AF with 89-90% improvement and the combination of FLPDL with electrosurgery, for the treatment of vascular and minimal fibrotic component of AF respectively, seems to be an alternative therapeutic tool. CO2 is used when the fibrotic component is prominent and in combination with FLPDL to improve the appearance of the vascular component. Hypertrophic scarring seems to be an important side effect of continuous wave CO2 lasers (39%) but the new scanning systems for CO2 lasers are very promising providing tissue depth control and minimal post-operative scarring. CONTINUOUS WAVE LASER THERAPY FOR ANGIOFIBROMATA OF TUBEROUS SCLEROSIS A.D.Pay, J.M.Kenealy, Laser Centre of the South West, Frenchay Hospital, Bristol B516 1LE Angiofibromata of the face (Adenoma Sebaceum) occur characteristically in Tuberous Sclerosis and cause significant cosmetic and hygienic morbidity. Treatment has previously included excision, dermabrasion, cryotherapy, electrocautery, argon and CO2 laser. Continuous Wave (Tunable Dye) Lasers(CWL) in single spot mode emit light at 585 nm (yellow) and are useful for treating vascular lesions. Previous experience with this laser in PortWine Stain patients has revealed a reduction in nodularity of some lesions and has led us to examine the efficacy of the CWL in treating the Adenoma Sebaceum of TSC. 13 patients with Adenoma Sebaceum of TSC were treated with the CWL. Individual lesions were treated with the laser at 585 nm at energy fluences of 1.2 to 1.6 J percm2. Intervals between treatment were a minimum of 8 weeks. Good to excellent results were seen in all patients. There was no scarring, hypo or hyperpigmentation in any of the treated group. 3patients have completed treatment with good control of their lesions. These patients may need further treatment as new lesions appear. We conclude that the Continuous Wave Laser (CWL) is a safe and effective means of treatment of Adenoma Sebaceum in Tuberous Sclerosis. This home page is intended to be a family resource for families affected by Tuberous Sclerosis. It does not intend to constitute medical advise. Viewers are warned not to take any action with regard to medical treatment relying on the information provided on this page without first consulting the patient's physician.
Deanna Runyan-Wall E-mail address: deannadawn@lukets.org Last updated: April 5, 2008 Created: December 5, 1996 |
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