Epidermal and sebaceous nevi treated with carbon dioxide laser

Introduction

Epidermal and sebaceous nevi are difficult to treat and often the therapeutic outcome is unsatisfactory or cosmetically unacceptable. CO2 laser is very versatile laser which can coagulate, vaporize or excise the tissue, therefore it has been successfully used to treat many lesions which were considered untreatable.[1],[2] Here we report our experience of treating 8 patients with epidermal and sebaceous nevi with good results.

Materials and Methods

Eight patients with epidermal and sebaceous nevi were taken up for this study in all the patients, a detailed clinical history including the duration of the lesion(s), evolution, symptoms if any, and the previous therapeutic modalities used, if any, were recorded. A thorough clinical examination of the lesions including the examination of the old injury scar, BCG scar etc, to look for the keloids/hypertrophic scars was performed. The diagnosis in each patient was made purely on the basis of clinical features. The patients with tendency to develop hypertrophic scars/keloids and with history of bleeding disorders were excluded from with diluted savlon and normal saline and anaesthetized with 2% lignocaine. The surgical laser system used was model C-40 unit, an indigenous carbon dioxide laser apparatus developed by Centre for Advanced Technology, Department of Atomic Energy, Indore, India. It employs Carbon dioxide, Nitrogen and Helium (1: 2.5: 12) gases to produce 10600 nm wavelength beam energy. The lesions were vaporized using a power setting of 10-20 watts delivered in continuous defocussed mode. The charred surface after laser ablation was cleaned with 3% hydrogen peroxide or saline. Topical antibiotic cream was used in all the patients till the laser induced ulcers healed. The patients were evaluated at the end of 1st, 2nd, 4th, 8th and 12th weeks to assess the therapeutic the study. The lesions were thoroughly cleaned response. Post treatment effects like colour changes, itching, pain, infection, scarring, atrophy and recurrence etc. if any, were also recorded. If there was no satisfactory improvement after the initial treatment, subsequent exposures were given.

The final assessment was done at the end of 12 weeks and the overall response was graded as: excellent if it regressed by 75% -100%, good if it was 50%-75% and poor if the improvement was less than 50%. The patients were then followed up every month for 6 months to look for any recurrence.

Results

The present study had 8 patients, 2 males and 6 females between 10-12 years in age. Four patients had asymptomatic epidermal naevi over the extremities, neck and trunk since less than one year of age. Three of these patients had excellent improvement while 1 patient with thick verrucous lesion responded poorly. Four patients had sebaceous nevi lesions over the forehead [Figure - 1], face and left preauricular area since birth. The lesions were asymptomatic in all the patients. At 12th week of treatment, there was very good improvement in 3 [Figure - 2] and good in 1 patient, though 2 of them had mild recurrence at the periphery after 8 weeks of therapy. Transient hypopigmentation of the treated site was seen in all the patients which healed in 3-4 months in all the patients.

Discussion

Various therapeutic modalities available for treatment of epidermal and sebaceous nevi are either partially effective, insufficient, cosmetically unacceptable or unapplicable particularly for large lesions. Carbon dioxide laser has been effectively used in many such situations with goods results.[1] In this study, 8 patients with epidermal and sebaceous nevi were treated on an outpatient basis with continuous wave defocussed mode CO2 laser using an irradiance of 320 watts/cm2 to 63,700 watts/ cm2. Out of 4 patients with epidermal nevi, 3 showed excellent (80-90%) improvement while 1 had poor (30%) response. The poor response in one patient could be due to very thick lesion where adequate removal could not be done in one sitting and the patient did not agree for subsequent exposures. Carbon dioxide laser has been found to be very effective in these nevi by other workers also.[3],[4],[5] Three out of 4 patients with sebaceous nevi showed excellent (90%) improvement as reported by other workers.[6] One patient with a thicker "U" shaped lesion also had good (60%) improvement. Mild recurrence at the periphery was seen in 2 patients after 8 weeks of therapy. We had a follow-up of 6 months only therefore, recurrences on a longterm follow-up and in a larger group of patients needs to be evaluated. In conclusion C02 laser seems to be a good therapeutic tool for treatment of epidermal and sebaceous nevi. However more experience is required to get better therapeutic outcome.