Dermabrasion and limited excision of the fibrous papules of tuberous sclerosis: case report

Rhinophyma in tuberous sclerosis complex: case report with brief review of literature

Tuberous sclerosis or tuberous sclerosis complex (TSC) is an autosomal dominant inherited disease characterized by the triad epilepsy, hamartomas (angiofibroma) and reduced intellectual capacity. Phenotype can vary considerably. Almost all patients with TSC have at least one characteristic dermatologic feature. Facial angiofibroma can cause severe disfigurement. It may involve the cheeks, perioral region and nose, resulting in thick layers of nodular and pustular skin. Aesthetic surgery of the face comprises an individually adapted ablation of the affected skin regions in order to improve physical appearance. Reports on the subject of surgery for nasal angiofibroma confirm the homogenous transformation of the connective tissues by this hamartoma. Hitherto there is only one report in the literature describing the typical epithelial alterations of the nasal skin compatible with a rhinophyma and adjacent angiofibroma. Here we report the successful electrosurgical treatment of a patient with TSC and extensive sebaceous glands giving rise to a rhinophyma in close association with angiofibroma.

Surgical management of chronic actinic dermatitis

SUMMARY

Chronic actinic dermatitis (CAD) is a persistent, ultraviolet (UV) radiation-induced eczema by either UVA, UVB or visible light. We present the case of a 48-year-old woman suffering from severe CAD. Various therapeutic approaches, including topical and local corticosteroids and other systemic immunosuppressives, were used without success, making surgical treatment the only option. Two sessions of manual dermabrasion were necessary to improve the cutaneous disorder. We document the successful treatment of a severe case of CAD with dermabrasion. Chronic actinic dermatitis (CAD) describes a serious and persistent photoinduced skin disorder. It is usually characterised by a perennial, chronic dermatitis that predominantly affects sun-exposed sites, but may also affect shaded sites or even present as erythroderma. Daily application of sun protection has to be combined with topical and local corticosteroids and other systemic immunosuppressives. However, these various therapeutic regimens are often limited by severe side-effects and consecutive failure of therapy. [Dawe RS, Ferguson J. Diagnosis and treatment of chronic actinic dermatitis. Dermatol Ther 2003;16:45-51 [review], Hawk JL, Magnus IA. Chronic actinic dermatitis: an idiopathic photosensitivity syndrome including actinic reticuloid and photosensitive eczema [proceedings]. Br J Dermatol 1979;101(Suppl. 17):24.].

Treatment of facial angiofibroma of tuberous sclerosis using cultured epithelial autografts

Treatment of facial angiofibroma of tuberous sclerosis is problematic, because the skin lesions involve entire dermis. Five patients aged from 14 to 33 (mean: 23.6) years old with angiofibroma of tuberous sclerosis were treated with cultured epithelial autografts between 1995 and 2004. The entire area of the facial lesions was excised using a razor to remove large nodules, and then the remaining lesions were further abraded to a rather deep layer of the dermis to smooth the skin and remove small nodules. Then a cultured autologous epithelium was grafted onto the wound. In all patients, epithelization was complete within 10 (mean: 9) days after the surgery. All patients were followed up for more than 6 months and showed neither depigmentation due to scar formation nor hypertrophic scars. In some patients, some pebbly regrowth had occurred at 5 years postoperatively, but the appearance was quite acceptable.

Extensive facial adenoma sebaceum: successful treatment with mechanical dermabrasion: case report

This report documents the successful elimination of disfiguring sebaceous adenomas from the face of a 21-year-old male patient with mechanical dermabrasion.

Treatment of facial angiofibromas of tuberous sclerosis by shave excision and dermabrasion in a dark-skinned patient

Tuberous sclerosis is an inherited disease expressed clinically by the triad of mental retardation, seizures, and tuberous lesions. Facial angiofibromas, a common manifestation of tuberous sclerosis, can cause considerable cosmetic disfigurement, emotional distress, obstruction of vision, and hemorrhage. Treatment by shave excision, as the first step to remove the larger nodules, followed by dermabrasion, to smooth and sculpt the final surface, has been recommended as the most effective form of therapy. However, this method of treatment raises the question of risk for development of hypopigmentation in susceptible patients. The authors present their treatment of angiofibromas with shave excision and dermabrasion in a dark-skinned patient.

Treatment of the facial angiofibromas of tuberous sclerosis

Tuberous sclerosis is an inherited syndrome with mental retardation, epilepsy, and acne rosacea being the classic triad of manifestations. The facial skin problems can present a cosmetic deformity or, as in the three patients presented here, can produce difficulties with hygiene and nasal breathing. Various approaches to treatment have been described over the last century, but no long-term results have been presented. Because of the full-thickness skin involvement, complete removal is not practical, and treatment should be directed toward acceptable long-term results with minimal surgical morbidity. Shaving and dermabrasion of the involved area produce very satisfactory results, but long-term follow-up of approximately 10 years reveals that there is a variable amount of recurrence and that subsequent treatment will be required.

Treatment of adenoma sebaceum with the copper vapor laser

BACKGROUND

Angiofibromas of the central part of the face (adenoma sebaceum) occur pathognomonically in tuberous sclerosis, causing significant cosmetic and hygienic morbidity. Treatment has included excision, dermabrasion, cryosurgery, carbon dioxide laser, and argon laser. Copper vapor lasers emit light at 511 nm (green) ad 578 nm (yellow), useful for treating pigmented and vascular lesions, respectively.

OBJECTIVE

Because of the vascular nature and progressive pigmentation of adenoma sebaceum, we examined the utility of the copper vapor laser in treating this disorder.

METHODS

Nine patients with adenoma sebaceum were treated with the copper vapor laser. Individual lesions were treated with the yellow light (578 nm) at 0.4 to 0.6 mW. Pigmented lesions or lesions resistant to treatment were treated with the green light (511 nm) at 0.4 to 0.9 mW. Intervals between treatments were at least 6 weeks.

RESULTS

Good to excellent cosmetic results were seen in all treated patients. Scarring or hyperpigmentation occurred in none of the patients. Most patients required additional treatments with the copper vapor laser as new lesions developed.

CONCLUSION

The copper vapor laser is safe and effective for the treatment of adenoma sebaceum in tuberous slerosis.

CO2, argon, and pulsed dye laser treatment of angiofibromas

BACKGROUND

Tuberous sclerosis is a complex disorder of hamartoma formation in many organs, particularly the skin, brain, eye, kidney, and heart. The characteristic skin lesions are angiofibromas (AF), the shagreen patch, periungual fibromas, and "ash-leaf" white macules. Treatment for AF has previously included electrocoagulation, electrodesiccation and curettage, dermabrasion, excision, cryosurgery, and oral 13-cis retinoic acid. Both argon and CO2 lasers have been used in isolated cases to treat AF.

OBJECTIVE

The purpose of this work is the study of the application of three different lasers in the treatment of facial AF.

METHODS

Ten patients with facial AF were treated with CO2, argon, and pulsed dye lasers. Patients' AF were graded with regard to the size and color of the lesions. A 2-3-cm2 test was assayed on the face of all patients with each laser before performing a complete treatment and in order to choose the best laser.

RESULTS

Results were considered excellent in seven patients and good in three patients, with decrease of erythema and flattening of the AF. Minimal scarring was noted in two patients. Transient erythema was observed in patients treated with the CO2 laser. All patients or their parents considered the treatment cosmetically satisfactory.

CONCLUSION

We found the CO2 laser to be a better therapeutic tool than the argon laser to treat AF, especially in those patients with multiple and protuberant AF. The argon laser would be more useful in those patients with very red AF and light complexion, and the pulsed dye laser in those with very red and flat AF.

Angiofibromas in tuberous sclerosis: comparison of treatment by carbon dioxide and argon laser

Multiple angiofibromas (adenoma sebaceum) of the nose in a dark-complexioned patient with tuberous sclerosis were treated with laser surgery. One side of the nose was treated with the argon laser. The other side of the nose was treated with the carbon dioxide (CO2) laser. The CO2 laser produced superior cosmetic results with more complete removal of cutaneous lesions.

Postdermabrasion leukoderma

Three patients developed leukoderma following dermabrasion during an attempt to correct the scarring sustained after a thermal burn injury several years previously. Two of the patients were successfully repigmented with autologous minigrafting and epidermal suction grafts.

Management of facial angiofibromas in tuberous sclerosis: use of the carbon dioxide laser

Facial angiofibromas are estimated to occur in 90% of patients with tuberous sclerosis and can cause considerable cosmetic disfigurement, emotional distress, obstruction of vision, and hemorrhage when abraded. Postoperative wound management associated with skin grafting and dermabrasion is often difficult because patients are mentally retarded and noncooperative. Three patients with extensive facial angiofibromas were treated successfully with the carbon dioxide (CO2) laser, with follow-up period ranging from 8 to 48 months. Uncomplicated wound healing occurred in each patient with minimal recurrence of lesions. Ablation with the CO2 laser is our treatment of choice for angiofibromas associated with tuberous sclerosis.

Cutaneous non-X histiocytosis: clinical and histologic features and response to dermabrasion

A 22-year-old man presented with a progressive cutaneous eruption consisting of reddish-yellow papules and plaques on his face, which was histopathologically characteristic of a non-X histiocytosis. No systemic involvement was present. Monoclonal antibody staining of the tissue infiltrate was strongly positive for only OKT6. On electron microscopy, Langerhans (Birbeck) granules were not found. Four years of conservative treatment was unsuccessful. Spontaneous involution did not occur. Dermabrasion not only produced excellent cosmetic results, but on rebiopsy the histiocytic infiltrate was absent. There has been no recurrence in treated areas after 18 months.

Rhinophyma in tuberous sclerosis

Search of the literature thus far indicates no prior description of rhinophyma occuring in tuberous sclerosis. There have been numerous reports of the usual skin lesion, adenoma sebaceum, together with the associated manifestations of severe mental retardation and convulsive seizures. In a 27-year-old woman, full-blown, severely deforming rhinophyma had its onset one year prior to her hospital admission. The family, horrified by her appearance, desired surgical intervention. The report includes a review of the literature and a description of the patient and of the surgical technique employed. The question of the desirability and difficulty involved in skin grafting is discussed, as are the microscopic findings and postoperative course. Particular attention is directed toward differential diagnosis and associated findings.