Periorbital Syringoma Treated With Radiofrequency and Carbon Dioxide (CO2) Laser in 5 Patients

July 2012 | Volume 11 | Issue 7 | Case Report | 879 | Copyright © 2012

Abstract

Syringomas are common benign eccrine ductal adnexial tumors, commonly found in periorbital area. Periorbital syringomas are aesthetically disturbing difficult to treat. Many treatment modalities are described in the literature, including topical and surgical methods, with potential problems such as postinflammatory hyper- and hypopigmentation, low efficacy, or scar formation. We present 5 patients with syringoma treated with the combination of radiofrequency ablation and carbon dioxide (CO2) lasers. Using low-energy parameters on the CO2 laser, and low energy on the radiofrequency, we could complement both treatments maximizing the destruction of the tumors and minimizing the adverse effects in only two sessions. This is a relatively easy, safe, and less painful treatment, with good cosmetic results on periorbital syringomas.

J Drugs Dermatol. 2012;11(7):879-880.

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INTRODUCTION

Syringomas are common benign eccrine ductal adnexial tumors, usually found in periorbital area. Clinically, they show as tan colored papules 1 mm to 3 mm in diameter. They usually appear at puberty or middle age. Females are affected more often than males.1

Periorbital syringomas are aesthetically disturbing and a difficult condition to treat. Many treatment modalities are described in the literature, topical treatments, using 1% atropine and tretinoin, have been reported with success in eruptive syringoma,2,3 while surgical methods include excision,4 dermabrasion,5 electrosurgery, 6 CO2 laser resurfacing,7 chemical peeling with tattoo and laser,8 and combinations thereof. These treatments have potential problems such as postinflammatory hyper- and hypopigmentation, low efficacy, or scar formation. We present a series of five patients treated with a treatment method for syringomas, which is easily performed, explicit, reproducible, and safe.

CASE REPORT

Five patients (1 male and 4 females), with mean age of 47 years, with periorbital syringomas were treated with radiofrequency and CO2 lasers. Prior to treatment, biopsies were performed on all patients to confirm the diagnosis.

On the procedure day, the treatment area was cleansed with sterile normal saline, following ablation of each syringoma with a 4.0 MHz radiofrequency generator (Elman Surgitron®), at its lowest power of 2 W, on a coagulation mode. A unipolar copper ball electrode was used on the hand and the antenna endplate was positioned beneath the back of each patient during the procedure. The ablated syringoma turned to a white ash, subsequently they were cleansed with a wet cotton stick. Afterwards, a carbon dioxide (CO2) laser (Silk Touch®) was used in pulsed or continuous ablative mode with a 2 mm diameter spot, at 1.5 W, into the skin of the entire periorbital region.

Postoperatively, topical antibiotics ointments were supplied for the first 3 to 5 days. Patients were instructed to avoid sun exposure and to use sunscreen after surgery.

Four weeks later, the patients received an ablation touch-up of any residual syringoma and were subsequently treated with the CO2 laser with the same parameters as in the first session.

The patients have been followed for a median follow-up period of 24 months since treatment (Figure 2). The treated lesions significantly improved on size and number, and not hyperpigmentation or scarring has been seen on any patient. Because of the good clinical efficacy and cosmetic outcome, the patients were very satisfied with this method.

DISCUSSION

It is well known that periorbital syringomas are aesthetically disturbing and difficult to treat. The best treatment outcome of syringoma requires complete destruction of tumors and minimal adverse effects, like erythema, hyper- or hypopigmentation, and scarring.

Carbon dioxide laser has been widely used for removal of skin tumors including syringomas. The CO2 laser is mainly absorbed into water and causes non-specific thermal damage. Thus, deep tumors are difficult to treat without causing damage to

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