[Long-term follow up of angiofibromas treated with CO2 laser in 23 patients with tuberous sclerosis].
BACKGROUND
Tuberous sclerosis is an autosomal dominant disease in which hamartomas form in multiple organs. Cutaneous changes are one of the primary characteristics of this disease. These include angiofibromas (AF), a common form of presentation that causes significant cosmetic and medical problems. The CO2 laser has been used satisfactorily in treating these lesions, but there are few studies that evaluate its long-term results. The aim of our study is to assess the long-term response of the treatment of angiofibromas.


METHODS
A retrospective study was carried out on 23 patients with angiofibromas treated with CO2 laser. The patients were treated between 1991 and 2000, inclusive, with continuous or superpulsed CO2 laser. We classified the angiofibromas by size, initial treatment results and patients' ages (< 20 years and 20 years or older).


RESULTS
Ages ranged from 12 to 39 years, with a median age of 22.5 years. After treatment, patients were followed up for a period of six months to 10 years. In the long-term analysis, we found that 30.1 % maintained the initial result, and 60.9 % showed different degrees of recurrence, with a mean recurrence time of 3 years. When we analyzed the long-term results by the size of the angiofibromas, initial result and patients' ages, we found no statistically significant differences among the different groups. The survival analysis of the age groups, with Kaplan-Meier curves, showed that the youngest patients (< 20 years) had earlier recurrences than the older ones (logarithmic range 4.01 and p < 0.05).


CONCLUSIONS
CO2 laser treatment achieves good short-term results. On the other hand, one of the biggest problems is recurrence over the long term; this is probably due to the fact that, because of their nature, these lesions cannot be eliminated permanently. This work coincides with earlier studies which found no factors that would make it possible to predict the recurrence of the lesions. However, we can conclude that recurrence takes place at a later date in older patients, and therefore they have better cosmetic results over the long term.
Servicio de Dermatología y Venereología, Hospital Ramón y Cajal, Madrid, Spain. pbelmarf@hotmail.com
Paulina
P
Belmar
Pablo
P
Boixeda
Ofelia
O
Baniandrés
Manuel
M
Fernández-Lorente
José María
JM
Arrazola
D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000150:complications* / Q000601:surgery*; D002245:Carbon Dioxide; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000150:complications* / Q000601:surgery*; D013997:Time Factors; D014402:Tuberous Sclerosis / Q000150:complications*
D002245:Carbon Dioxide