CO2, Er:YAG and Pulsed Dye Laser Treatment of Angiofibromas in Patients with Tuberous Sclerosis

Summary Background: Facial angiofibromas in tuberous sclerosis have been treated using various methods, without reproducible efficiency. Laser therapy could be a viable alternative. Objective: The purpose of this study was to evaluate the efficacy and side-effects of pulsed CO2 laser (10600 nm wavelength) or Erbium-YAG laser (2940 nm wavelength), and 595 nm wavelength pulsed dye laser in the treatment of facial angiofibromas. We attempted to make a comparison between these two treatments, and to perform a clinical assessment of pulsed CO2 laser or Erbium-YAG laser and pulsed dye laser treatment of angiofibromas. Methods: We treated 18 patients. We utilised a 595 nm wavelength pulsed dye laser, using a skin cooling system (Spray or Cryo), with a 7 mm spot size, energy density (fluence J/cm2) from 6 to 8 J/cm2, emission modality (repetition rate) at 0.5 Hz to 2, and a short pulse duration of 2 to 0.5 msec or Erbium-YAG laser (1000 mJ, 200 s); KTP 532 nm; Nd:YAG 1064 long pulse (300 J/cm2, 50 ms); and pulsed CO2 laser. Results: Nine patients with fibrous angiofibromas of the entire face were treated using pulsed CO2 laser (ultra or superpulsed). The patients treated showed remarkable cosmetic improvements, without scarring. Mild hyperpigmentation was observed in 2/9 patients, which disappeared within 6 months. Facial erythema persisted for about 2 months in 5/9 patients. The results on fibrous and protuberant angiofibromas were good, with an improvement of 51–75% of the lesions. Seven patients were satisfied after the first pulsed CO2 laser treatment, and only 2 required 1 further treatment at 6-month intervals (mean number of treatments: 1.22). Er:YAG laser was used for 4 patients, with 1 to 2 sessions at 2-month intervals, with good improvement on the fibrous component, and limited adverse effects (1 patient developed hypochromia). Vascular lasers were used for 11 patients. The pulsed Nd:YAG KTP (532 nm) (3 patients) and Nd:YAG-long pulse 1064 nm (1 patient) was used to times and always required the use of another type of laser. With the use of the Nd:YAG KTP (532 nm) a perinasally localised scar occurred. Conclusions: Laser therapy is indicated for angiofibromas in the first instance. Carbon dioxide laser is advocated as the preferable treatment for fibrous or protuberant angiofibromas, while pulsed dye laser is more successful for those with a vascular component. The CO2 laser, however, involves a risk of depigmentation or scarring, so that a combination of lasers may be required to achieve the best results.