title: Treatment of angiofibromas with a scanning carbon dioxide laser: a clinicopathologic study with long-term follow-up.
abstract: BACKGROUND
  Facial angiofibromas in tuberous sclerosis have been managed with various treatment modalities, including carbon dioxide (CO(2)) laser resurfacing.
  
  
  OBJECTIVE
  Our purpose was to perform a long-term clinicopathologic assessment of CO(2) laser treatment of angiofibromas.
  
  
  METHODS
  This was a retrospective case review of 10 patients treated with a scanning CO(2) laser to flatten lesions. Baseline clinical photographs and those taken at 6, 12, and 24 months after the operation were assessed by a blinded observer. Patients also evaluated outcomes. Biopsy specimens taken immediately and at 4 months after the operation were reviewed.
  
  
  RESULTS
  Three groups of patients were identified: the first comprised 2 patients with sustained excellent and good outcomes. A second group (3 patients) had excellent outcomes in the early and medium term but then demonstrated partial deterioration. The last group (5 patients) had a range of early results with invariably poor outcomes at 24 months. In contrast, patients' self-assessment at 24 months was good or excellent in 8 of 10 cases. All biopsy specimens taken immediately after the procedure demonstrated ablation extending into the papillary dermis. Residual angiofibromas were present in 6 biopsy specimens. At 4 months, all biopsy specimens showed a band of superficial dermal fibrosis, but distinguishing between this and adjacent angiofibromas was often difficult. Long-term side effects included 2 cases of subtle hypopigmentation.
  
  
  CONCLUSIONS
  The long-term results of CO(2) laser treatment of angiofibromas are unpredictable. The marked improvement obtained at 6 months is sustained in only a minority of cases at 24 months. Despite this, patient satisfaction appears relatively high. Initial clinical improvement may be the result of a combination of destruction of angiofibromas and their sequestration under postoperative fibrosis. The benefits of therapy should be weighed against both early morbidity and the risks of long-term complications such as scarring and hypopigmentation.
authors.affiliation: Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London SE1 7EH, UK.
authors.forename: R C
authors.initials: RC
authors.lastname: Bittencourt
authors.forename: S C
authors.initials: SC
authors.lastname: Huilgol
authors.forename: P T
authors.initials: PT
authors.lastname: Seed
authors.forename: E
authors.initials: E
authors.lastname: Calonje
authors.forename: A C
authors.initials: AC
authors.lastname: Markey
authors.forename: R J
authors.initials: RJ
authors.lastname: Barlow
mesh_terms: D000328:Adult; D000368:Aged; D018322:Angiofibroma / Q000473:pathology / Q000628:therapy*; D002921:Cicatrix / Q000209:etiology; D005260:Female; D006801:Humans; D017496:Hypopigmentation / Q000209:etiology; D053685:Laser Therapy; D007834:Lasers / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome