ORLANDO CO2 laser ablation with aggressive curettage proved successful for the treatment of a patient with Darier's disease who had failed other medical therapies.
The CO2 laser/curettage approach was initially used on one part of the patient's abdomen, and the results compared favorably with results following wire brush dermabrasion on another part of her abdomen, reported Dr. Tri H. Nguyen at the annual meeting of the Florida Society of Dermatologic Surgeons.
The areas looked similar postoperatively, with erythema appearing on the CO2 laser-treated area at short-term follow-up, and the beginning of hypertrophic scarring in the dermabraded area (this resolved with flurandrenolide tape). The erythema resolved over time.
The patient was greatly affected by this "horrible" disease, said Dr. Nguyen, associate professor of dermatology, and director of Mohs micrographic and dermatologic surgery at the University of Texas M.D. Anderson Cancer Center, Houston. She had chronic maceration, malodor, repeat infections, and mastitis, and her daily activities were restricted by her symptoms.
After successfully treating a number of cases of Hailey-Hailey disease with the CO2 laser/curettage approach, Dr. Nguyen thought it might prove useful in this patient since both diseases require treatment that produces lesion destruction and scarring to achieve long-lasting remission.
She had failed numerous other therapies, including systemic and topical antibiotics, topical retinoids, and laser treatments.
The CO2 laser/curettage treatment was performed under tumescent anesthesia; the patient also received oral anxiolysis with lorazepam and oral oxycodone and acetaminophen (Percocet). The CO2 laser was used on continuous wave mode at up to 40 W. Sometimes 1520 W were used, but Dr. Nguyen said he never went below that setting on the first pass "because the plaques were so hyperkeratotic."
The skin was treated in a grid pattern to ensure uniformity.
Based on the initial success, the patient was treated subsequently on other areas where she experienced the most difficulties with symptoms, malodor, and infection. The resulting smooth, flat scars which fade from the initial erythema into hypo- or depigmented scars have proved to be a "much better alternative" to the hyperkeratotic Darier's lesions, he said. The patient has been extremely satisfied with the results, and has returned repeatedly for treatment of additional areas.
Dr. Nguyen had no relevant conflicts of interest to disclose.
The resulting scars have proved to be a 'much better alternative' to the hyperkeratotic Darier's lesions. DR. NGUYEN