Treatment of a Symptomatic Dermatofibroma With Fractionated Carbon Dioxide Laser and Topical Corticosteroids
December 2013 | Volume 12 | Issue 12 | Case Reports | 1483 | Copyright © December 2013
Audrey S. Wang MD,a Larissa Larsen MD,a Shurong Chang MD PhD,a Tiffany Phan BA,a Jared Jagdeo MD MSa,b,c
aDepartment of Dermatology, University of California, Davis, Sacramento, CA
bDermatology Service, Sacramento Veterans Affairs Medical Center, Mather, CA
cDepartment of Dermatology, SUNY Downstate, Brooklyn, NY
Abstract
Dermatofibromas are benign skin lesions that may be treated if symptomatic or for cosmetic concerns. We present a case of an African American woman with an enlarging, pruritic dermatofibroma on the thigh that was treated with fractionated carbon dioxide (CO2) laser three times approximately 5 weeks apart. Between laser treatments, topical corticosteroids were applied to the lesion for a total of 13 weeks. The dermatofibroma completely flattened and became asymptomatic within 1 month after the final laser treatment. We hypothesize that the fractionated CO2 laser ablated a portion of the stromal component of the lesion and introduced microscopic channels that facilitated deeper penetration of the topical corticosteroids into the lesion. This is the first reported case demonstrating the successful treatment of a symptomatic dermatofibroma using combination therapy with fractionated CO2 laser and topical corticosteroids.
J Drugs Dermatol. 2013;12(12):1483-1484.
INTRODUCTION
Dermatofibromas are common benign tumors of the
skin. They are often cosmetically undesirable and
typically asymptomatic but may become tender or
pruritic, prompting patients to seek treatment. Common treatments
for dermatofibromas include cryotherapy, surgical excision,
and intralesional steroid injections, which may result in
incomplete resolution, scarring, atrophy, and hypopigmentation.
More recently, the non-ablative pulsed dye laser (PDL)
has been described as an alternative therapy with variable
efficacy.1,2 Adverse effects associated with PDL treatment of
dermatofibromas include post-inflammatory hyperpigmentation,
which resolved within 6 months in one study.2 Unlike
PDL, fractionated CO2 laser is an ablative modality.3 Potential
adverse effects include pain, bleeding, scarring, and pigmentary
alteration. Fractionated CO2 laser has been used for the
treatment of various epidermal and dermal lesions,3 but only
one other report has described its efficacy in treating dermatofibromas.
4 The authors presented a patient with multiple
facial dermatofibromas who underwent CO2 laser treatment
(settings not specified) with minimal scarring and no recurrence
at 8-month follow-up.4
CASE REPORT
A 47-year-old African American woman presented with a 1 cm
raised dermatofibroma on her left thigh (Figure 1). It had been
present for 4 years, but because it was becoming larger and
increasingly pruritic, she expressed interest in treatment. We
treated the dermatofibroma with the DEKA SmartXide DOT HP
fractional CO2 laser (DEKA Medical, San Francisco, CA) three
times approximately 5 weeks apart (Table 1). We reduced the
laser spot size as the lesion size decreased. After the first laser
treatment, she also applied fluocinonide 0.05% ointment to the
treated site twice daily for 9 weeks. Due to improvement in the
lesion, she was tapered to triamcinolone 0.1% ointment twice
daily for an additional 4 weeks. By one month after the final
laser treatment, she noted complete flattening of the lesion and
resolution of her pruritus. At her 7-month follow-up appointment,
mild peri-lesional post-inflammatory hyperpigmentation
was seen, but there was no evidence of recurrence of the dermatofibroma
(Figure 2). The patient tolerated her treatment
well and was very pleased with the outcome.
DISCUSSION
The mechanism by which dermatofibromas respond to fractionated
CO2 laser and corticosteroid therapy has not been fully
elucidated. Laser-induced damage to the collagenous stroma of
the dermatofibroma may facilitate reduction in lesion size and
volume.2 In addition, corticosteroids decrease collagen synthesis
by suppressing the inflammatory process and inhibiting
fibroblast proliferation through reducing pro-fibrotic growth
mediators, specifically transforming growth factor-beta and
insulin like growth factor-1.5 Thus, the microscopic channels
created by the fractionated CO2 laser may have enhanced topical
corticosteroid delivery to the dermis to achieve a synergistic
anti-fibrotic effect in our patient. The authors of a recent case
series describing same-session ablative fractional laser therapy
and topical corticosteroid application for hypertrophic scars
also proposed a similar mechanism.6