Recurrent granuloma faciale successfully treated with the carbon dioxide laser

Madan,

doi:10.4103/0974-2077.85050

Cited by 9 publications

(7 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 The more recent use of a scanningassisted CO2 laser can however, reduce these adverse effects. 11 There are a few cases in which the argon laser was effective, 12 however, this benefit was limited by the development of collagenous scars.…”

Section: Discussionmentioning

confidence: 99%

Complete Clearance of Resistant Granuloma Faciale With Pulsed Dye Laser After Pre-treatment With Mometasone and Tacrolimus

Micallef

Boffa

2017

J Lasers Med Sci

View full text Add to dashboard Cite

IntroductionGranuloma faciale is an uncommon, idiopathic, inflammatory dermatosis that usually affects the face.1 Despite its benign nature, the condition tends to be persistent, can be cosmetically distressing and is notoriously difficult to eradicate completely. 2 We report a case of successful treatment of granuloma faciale using 595-nm pulsed dye laser following topical mometasone and tacrolimus. Case PresentationA 39-year-old English lady with Fitzpatrick skin phototype II, presented to our Dermatology Department with 3 sharply-demarcated, reddish-brown, indurated plaques with accentuated follicular openings and few superficial telangiectases. These were present on both cheeks and the tip of the nose. The patient had been previously diagnosed with granuloma faciale in the United Kingdom 6 months previously and was started on dapsone 50 mg daily, to which there was no visible response. The patient then moved to Malta where dapsone was stopped and the lesion on the right cheek biopsied. The biopsy showed a dense neutrophilic and eosinophilic infiltrate within the papillary and reticular dermis, with a prominent Grenz zone, confirming the diagnosis of granuloma faciale. At this point, treatment with pulsed dye laser was attempted. A test area in the right cheek lesion underwent two treatments with a ScleroPlus pulsed dye laser (Candela Corporation, Wayland, Mass) with cryogenspray dynamic cooling. A wavelength of 595 nm and pulse duration of 1.5 ms were used, with a 7 mm spot at a fluence of 8.5 J/cm 2 for the first session and 9.5 J/ cm 2 for the second session, carried out after an interval of 8 weeks. There was no visible improvement with this treatment. The patient was lost to follow-up but re-presented 5 years later with the same lesions, which by then had become more prominent. She was prescribed mometasone 0.1% ointment once daily for 2 months, with no visible improvement. Tacrolimus 0.1% ointment twice daily was then added to the mometasone ointment for another 2 Case Report Abstract Introduction: Granuloma faciale is an uncommon inflammatory dermatosis which usually affects the face and is often resistant to treatment. Case Report: A 39-year-old English lady with Fitzpatrick skin phototype II presented with typical lesions of granuloma faciale, confirmed on biopsy, on her cheeks and nose. Treatment with ScleroPlus pulsed dye laser (Candela Corporation, Wayland, Mass) produced no visible improvement. The patient re-presented 5 years later with the same lesions, now more prominent. No improvement was noted with topical mometasone, however addition of topical tacrolimus caused significant flattening. Since the erythema and telangiectases persisted, treatment with ScleroPlus pulsed dye laser was re-attempted. Treatments were performed with a wavelength of 595 nm, pulse duration of 1.5 ms and 7 mm spot at a fluence of 8.5 J/cm2 in the first session and 9.5 J/cm 2 in the subsequent 2 sessions. This resulted in complete resolution without scarring or pigmentary change. There was no recurrence at follow-up ...

show abstract

Section: Discussionmentioning

confidence: 99%

Complete Clearance of Resistant Granuloma Faciale With Pulsed Dye Laser After Pre-treatment With Mometasone and Tacrolimus

Micallef

Boffa

2017

J Lasers Med Sci

View full text Add to dashboard Cite

show abstract

“…Medical treatments are burdened by high risk of relapse after discontinuation, whereas ablative and surgical procedures may cause scarring or post‐inflammatory pigmentation . Several types of laser, such as 585 nm PDL , argon , KTP 532‐nm , and CO 2 have been applied, achieving different cosmetic results. The 585 nm PDL targets the oxyhemoglobin in blood vessels, resulting in selective photothermolysis and the prominent telangiectasia of GF suggests that it may be effective in the treatment of these lesions .…”

Section: Discussionmentioning

confidence: 99%

“…However, the low depth penetration of these wavelengths is not able to significantly improve severe exophityc GF. CO 2 lasers (targeting water) vaporize tissues in a non‐selective manner and carry the risk of scarring or hypopigmentation ; however, the esthetic outcome depends on the operator and the laser type. Madan obtained good cosmetic results in GF patients using the scanner‐assisted Sharplan 40C CO 2 (Sharplan Lasers, Marlton, NJ) in silktouch mode (spot size 4 mm, 12 W).…”

Section: Discussionmentioning

confidence: 99%

“…CO 2 lasers (targeting water) vaporize tissues in a non‐selective manner and carry the risk of scarring or hypopigmentation ; however, the esthetic outcome depends on the operator and the laser type. Madan obtained good cosmetic results in GF patients using the scanner‐assisted Sharplan 40C CO 2 (Sharplan Lasers, Marlton, NJ) in silktouch mode (spot size 4 mm, 12 W). Bakkour and Madan have successfully treated a rhinophyma‐like GF with a CO 2 laser (MCO 50plus; KLM Martin, Tuttlingen, Germany) in scanning mode (spot size 4‐6 mm, power 22 W, 0.15 ms dwell time); whereas the use of continuous mode CO 2 laser (beam size 0.5 mm, 5 W) resulted in residual scarring .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

“Drug-resistant granuloma faciale”: treatment with carbon dioxide-GaAs laser

Paradisi

Ricci²,

Sbano

2016

Dermatologic Therapy

View full text Add to dashboard Cite

Granuloma faciale (GF), also known as "eosinophilic granuloma," is a rare benign leukocytoclastic vasculitis which most commonly occurs on the face of middle-aged Caucasian males. Clinically, GF appears as single or multiple, slowly growing, reddish-brown papules, nodules or plaques which may be cosmetically unpleasant. Its pathogenesis is unknown and GF is notoriously resistant to treatments. Both medical (dapsone, colchicine, gold injections, isoniazid, clofazimine, corticosteroids, psoralen ultraviolet radiation, and topical tacrolimus) and surgical therapies (excision, graft, dermabrasion, argon laser, carbon dioxide laser, pulsed dye laser, cryotherapy, and electrosurgery) have been used for GF but no effective treatment has yet been found. Furthermore, the typical facial location of GF requires an acceptable cosmetic result. We report two cases of drug-resistant GF which were successfully treated with laser vaporization combining two different wavelengths: carbon dioxide (CO ) 10,600 nm and GaAs 1540 nm.

show abstract

“…Rhinophyma [Figures 3a and b ] can be recontoured for cosmetic purposes and in order to relieve nasal obstruction. [ 2 ] Other dermatological conditions which can be ablated in this way include warts, granuloma faciale,[ 3 4 ] plaques of Hailey-Hailey and Darier's disease. Vulval lymphangiectasia/lymphangioma can be ablated to produce a degree of fibrosis thus preventing the recurrence.…”

Section: Laser Proceduresmentioning

confidence: 99%