Ann Dermatol.  2019 Oct;31(5):555-558. 10.5021/ad.2019.31.5.555.

Use of Topical Rapamycin as Maintenance Treatment after a Single Session of Fractionated COâ‚‚ Laser Ablation: A Method to Enhance Percutaneous Drug Delivery

Affiliations
  • 1Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea. juhee@yuhs.ac
  • 2Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder with an incidence of approximately 1 in 5,000 to 10,000 live births. TSC has various clinical manifestations such as multiple hamartomas in systemic organs, including the skin. Angiofibromas are the most common skin lesions in patients with TSC. Although benign, angiofibromas develop in childhood and puberty, and can be psychosocially disfiguring for patients. Skin lesions in TSC, specifically angiofibromas, have no significant risk of malignant transformation after puberty; thus, they require no treatment if not prominent. However, the presentation of TSC is important owing to its impact on patient cosmesis. Surgical treatment and laser therapy are the mainstream treatments for angiofibromas. Although the evidence is limited, topical mammalian target of rapamycin inhibitors such as sirolimus (rapamycin) are effective in facial angiofibroma treatment. We describe an adult patient with an angiofibroma who had an excellent response to treatment with topical rapamycin after a single session of carbon dioxide (COâ‚‚) laser ablation. The patient showed no sign of relapse or recurring lesions for a year. COâ‚‚ laser ablation may serve as a new paradigm of treatment for angiofibromas in TSC. Since the selection of laser devices can be limited for some institutions, we suggest a rather basic but highly effective approach for angiofibroma treatment that can be generally applied with the classic COâ‚‚ device.

Keyword

Angiofibroma; COâ‚‚ laser; Sirolimus; Tuberous sclerosis complex

MeSH Terms

Adolescent
Adult
Angiofibroma
Carbon Dioxide
Hamartoma
Humans
Incidence
Laser Therapy*
Live Birth
Methods*
Neurocutaneous Syndromes
Puberty
Recurrence
Sirolimus*
Skin
Tuberous Sclerosis
Carbon Dioxide
Sirolimus

Figure

  • Fig. 1 Improvement of facial angiofibroma lesions in a 20-year-old patient with tuberous sclerosis complex during rapamycin therapy after a single session of CO2 laser ablation. Left panels, labeled 0: before the administration of laser ablation. Pronounced improvement was observed at 1, 3, 6, and 8 months after the start of systemic rapamycin therapy after a single session of CO2 laser ablation.


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