Multiple dermatofibromas on face treated with carbon dioxide laser: The importance of laser parameters

Sir,

Dermatofibroma (DF) is one of the common dermatologic diseases treated by practicing dermatologists. ^[1] The use of carbon dioxide laser has emerged as an effective option for treatment of numerous epidermal and dermal dermatological lesions, including benign and malignant growths, keloids, vascular deformities, warts and tattoos. ^[2] The focus has now shifted from continuous wave (CW) to super-pulse (SP) and now ultrapulse (UP) mode. ^[3] The latter mode combines efficacy and minimal tissue damage and is preferred by most laser surgeons worldwide. ^[3]

The case published ^[4] highlights two concepts. One the use of CO ₂ laser, and second its apparent beneficial effects on fibrosis. But surprisingly, no mention is made of some standard facts that are mandatory in laser article publications worldwide: ^[3] the type of laser, the make, the mode used (CW, SP, UP), the sub-mode used (continuous, repeat, pulsed), the energy used (joules/cm ² ) and in most pulsed surgery - the total power (W), power/pulse (mJ), pulse width (in µs), frequency (Hz) and pulse diameter. ^[3]

Nowadays, it is routine to use a two-step procedure, first to debulk the tissue with CW mode and then to destroy the base with UP mode, with the end-point varying depending on the lesion to be treated. ^[3] This use of UP mode ensures better cosmesis. ^[3] Notwithstanding the high recurrence that is the norm in similar conditions with fibroblastic proliferation like keloids, ^[3] it is heartening to note the decent results obtained by the authors. ^[4] But, we were surprised to note that no mention was made of a previous study on 18 patients (20 lesions) with PDL where 15 of 20 lesions (75%) responded. ^[5] With so little on the subject, a proper perspective was warranted in the article on whether PDL is superior to CO ₂ or not.