A Systematic Review of Laser Treatment for Angiofibromas in Tuberous Sclerosis

Abstract

BACKGROUND While mammalian target of rapamycin inhibitors have revolutionized the management of angiofibroma in tuberous sclerosis complex (TS), physical modalities such as laser are still indicated for recalcitrant lesions. OBJECTIVE The authors performed a systematic review of the efficacy and safety of laser treatment for TS-related facial angiofibroma. METHODS The electronic databases such as MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to October 10, 2023, for eligible records. RESULTS Forty-seven articles met the inclusion criteria, representing a total of 217 patients with TS-related facial angiofibroma who received laser treatment. Several lasers have been trialed in patients including carbon dioxide (n = 95, 43.7%), pulsed dye (n = 21, 9.7%), argon (n = 16, 7.4%), neodymium-doped: yttrium aluminum garnet (n = 12, 5.5%), copper vapor (n = 9, 4.1%), potassium titanyl phosphate (n = 7, 3.2%), erbium: yttrium aluminum garnet (n = 2, 0.9%), lasers and various combination therapies (n = 55, 25.3%). CONCLUSION Potassium titanyl phosphate, pulsed dye, and neodymium-dopsed:yttrium aluminum garnet lasers are better suited to manage the vascular components of angiofibroma while ablative lasers such as erbium: yttrium aluminum garnet and carbon dioxide lasers may present better options for lesions with a prominent fibrous component. While several lasers have been trialed with broadly favorable results, the low level of evidence precludes definitive conclusions, and no single laser appears superior.