BOSTON – Fractional ablative carbon dioxide lasers are safe and effective for the treatment of mild to moderate rhinophyma, investigators reported at the annual meeting of the American Society for Laser Medicine and Surgery.
Patients with rhinophyma who were treated with a fractional ablative CO2 laser had less downtime and good cosmetic results with few complications compared with other therapies in a case series of five patients, reported Dr. Kathryn Serowka, a dermatology resident at the University of California at Irvine.
"All our patients show complete re-epithelialization within 4-7 days, edema and erythema are mild and self-limited, and there is a low risk for adverse events, Dr. Serowa said. "We recommend this treatment for your patients with mild to moderate rhinophyma, as you’re not going to get the efficacy of a fully ablative laser, but by using higher [energy] densities, you can get good debulking while still maintaining the advantages of your fractionated treatment," she said.
Rhinophyma is a common form of rosacea characterized by erythema, sebaceous hyperplasia, and nodular swelling of skin on the nose. The comedian W.C. Fields, with his famously bulbous nose, is probably the best known example of a person with rhinophyma, Dr. Serowka noted.
Many treatments for rhinophyma have been tried, alone or in combination, and many have been found wanting, she said. Treatments include loop cautery argon laser, dermabrasion, cryotherapy, radiotherapy, full-thickness excision, skin graft, flap reconstruction, and cold scalpel.
CO2 laser resurfacing is effective, and it is often regarded as a first-line therapy for significant debulking of severe rhinophyma, with the potential for dramatically improving the texture and contour of the nose. But fully ablative CO2 lasers have a high side-effect profile, and have the potential to cause persistent erythema and edema, scarring, and loss of pigmentation.
In contrast, fractional ablative lasers allow delivery of thermal energy to tissue in an array of microscopic treatment zones surrounded by uninvolved skin. Following laser application, the untreated skin areas can rapidly repopulate the ablated areas of tissue, leading to healing with shorter downtime and minimal side effects.
Although the settings vary slightly according to the device used, Dr. Serowa and colleagues set their laser at 70 mJ energy at 70% density for 8 passes, but instead deliver the energy in 14-18 passes, yielding an approximate energy density of 92%.
"This allows for significant debulking of the nose, and we can then perform fewer passes and lower our density in the less sebaceous areas of the nose, and feather the treatment at the periphery in order to get a natural, blended appearance," she said.
Because of the significant tissue debulking involved, Dr. Serowa and colleagues give patients herpes simplex virus prophylaxis with acyclovir or valacyclovir prior to treatment, and all are anesthetized with a lidocaine and epinephrine regional perinasal nerve block.
Patients are discharged from the clinic with instructions for wound care with daily changes of dressing for the week after surgery, Dr. Serowka said. But most do not require pain medication, because discomfort with the procedure is minimal, she added.
In her experience, patients with mild to moderate rhinophyma had significant physician-rated and patient-rated reduction of rhinophyma and improvement of appearance with no adverse events and no scarring, she said.
The study was internally funded. Dr. Serowka had no financial conflicts to disclose.