Laser remodelling of nodular nasal lupus pernio.

Abstract

Disfiguring nodular nasal lupus pernio is a rare condition that responds poorly to medical management. We have treated three affected patients with carbon dioxide laser remodelling, and report their progress 6 years, 2 years and 16 months following treatment, respectively. Although the abnormal granulomatous tissue was debulked rather than completely excised, the wounds healed within 4 weeks in all patients. The cosmetic results are acceptable and have been maintained in two of the patients, perhaps a reflection of their overall systemic sarcoidosis control.

Sarcoidosis

“…All patients received systemic steroids at the start of phototheapy. 198 Case reports have described improvement or resolution of skin lesions, especially popular and nodular sarcoidosis, scar sarcoidosis, and lupus pernio, 199 with several lasers, including pulsed dye laser (PDL), [200][201][202] carbon dioxide (CO 2 ), 203,204 neodymium:yttrium aluminum garnet, 205 and Q-switched ruby lasers. 206 In one of these reports, significant improvement of lupus pernio recalcitrant to systemic steroids and steroid-sparing agents was achieved with PDL therapy followed by nonablative fractional resurfacing.…”

Nasal sarcoidosis: a cause for a medical rhinoplasty?

“…7,8 Pharmacological agents which are known to have measurable success in treating persistent, widespread sarcoidosis include allopurinol, infliximab, hydroxychloroquine, methotrexate and retinoids. 1,9,10 Triamcinolone is a long-acting, synthetic corticosteroid given orally, by injection (40 mg/ml, under local anaesthesia if needed), by inhalation, or as a topical ointment or cream.…”

Cutaneous sarcoidosis therapy updated

“…133 Laser therapy may be advantageous over conventional surgical interventions because laser provides relatively precise resculpting and a possible bloodless field. 134 In the mid-1980s, reports of laser-treated sarcoidosis began to surface. Over the next several years, clinicians continued to experiment with a variety of lasers with or without concurrent medical therapy.…”

“…137,138 More recently, O'Donoghue and Barlow 134 treated 3 patients with CO 2 laser for nodular nasal lupus pernio with variable outcomes. 134 Two of 3 patients required postlaser intralesional triamcinolone for residual lesional tissue, with one patient also requiring 5 mg prednisone daily for systemic sarcoidosis. 134 The patient treated with laser, intralesional triamcinolone, and systemic steroids remained free of cutaneous lesions for 6 years, and the patient treated with laser alone had been disease-free for 14 months.…”

“…134 Two of 3 patients required postlaser intralesional triamcinolone for residual lesional tissue, with one patient also requiring 5 mg prednisone daily for systemic sarcoidosis. 134 The patient treated with laser, intralesional triamcinolone, and systemic steroids remained free of cutaneous lesions for 6 years, and the patient treated with laser alone had been disease-free for 14 months. The remaining patient developed partial recurrence of nasal swelling 9 months after laser therapy despite post-laser intralesional triamcinolone.…”