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
