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  In this article
    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    References

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ORIGINAL ARTICLE
Year : 2002  |  Volume : 68  |  Issue : 1  |  Page : 23-24

Epidermal and sebaceous nevi treated with carbon dioxide laser


Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, 110 029, India

Correspondence Address:
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, 110 029, India
kkverma61@hotmail.com

   Abstract 

Eight patients, 2 males and 6 females, between 10-21 years in age with epidermal (4) and sebaceous nevi (4) were taken up for this study. The lesions in all the patients were vaporized with the indigenously developed carbon dioxide laser. All the patients were evaluated at 1, 2, 4, 8 and 12 weekly visits. The final evaluation was done at the 12 weekly visit to assess the overall response to the treatment and side effects. The patients were then followed up every month for 6 months to look for any recurrence. All the patients responded to the treatment. Three patients each with epidermal and sebaceous nevi had 8090% improvement while I patient each with above disorders had % and 60% improvement respectively. Transient hypopigmentation was seen in all the patients. There were no other significant side effects.

How to cite this article:
Verma KK, Ovung E M. Epidermal and sebaceous nevi treated with carbon dioxide laser. Indian J Dermatol Venereol Leprol 2002;68:23-4


How to cite this URL:
Verma KK, Ovung E M. Epidermal and sebaceous nevi treated with carbon dioxide laser. Indian J Dermatol Venereol Leprol [serial online] 2002 [cited 2019 Oct 18];68:23-4. Available from: http://www.ijdvl.com/text.asp?2002/68/1/23/12860



   Introduction Top


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 Top


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 Top


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 Top


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. 

   References Top

1.McBurney El. Carbondioxide laser treatment of dermatologic lesions. South Med J 1978;71:795-797.  Back to cited text no. 1    
2.Nelson SJ. Lasers: State of art in dermatology. Dermatol Clin 1993;11:15-26.  Back to cited text no. 2    
3.Hohenleutner U, Wlotzke U, Konz B, et al. Carbondioxide laser therapy of a widespread epidermal nevus. Lasers Surg Med 1995;16: 288-291.  Back to cited text no. 3    
4.Hohenleutner U, Landthaler M. Laser therapy of verrucous epidermal naevi. Clin Exp Dermatol 1993;18:124-127.  Back to cited text no. 4    
5.Ratz JL, Bailin PL, Wheland RG. Carbon dioxide laser of epidermal nevi. J Dermatol Surg Oncol 1986;12: 567-570.  Back to cited text no. 5    
6.Ashinoff R. Linear nevus sebaceus of Jadassohn treated with the carbondioxide laser. Pediatr Dermatol 1993;10:189-191.  Back to cited text no. 6    

 

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