Micallef Daniel, Boffa Michael J
Higher Specialist Trainee in Dermatology, Sir Paul Boffa Hospital,Harper Lane, Floriana FLR1940, Malta.
Consultant Dermatologist and Senior Lecturer in Dermatology, Sir Paul Boffa Hospital, Harper Lane, Floriana FLR1940, Malta.
J Lasers Med Sci. 2017 Spring;8(2):95-97. doi: 10.15171/jlms.2017.17. Epub 2017 Mar 28.
Granuloma faciale is an uncommon inflammatory dermatosis which usually affects the face and is often resistant to treatment. A 39-year-old English lady with Fitzpatrick skin phototype II presented with typical lesions of granuloma faciale, confirmed on biopsy, on her cheeks and nose. Treatment with ScleroPlus pulsed dye laser (Candela Corporation, Wayland, Mass) produced no visible improvement. The patient re-presented 5 years later with the same lesions, now more prominent. No improvement was noted with topical mometasone, however addition of topical tacrolimus caused significant flattening. Since the erythema and telangiectases persisted, treatment with ScleroPlus pulsed dye laser was re-attempted. Treatments were performed with a wavelength of 595 nm, pulse duration of 1.5 ms and 7 mm spot at a fluence of 8.5 J/cm in the first session and 9.5 J/cm in the subsequent 2 sessions. This resulted in complete resolution without scarring or pigmentary change. There was no recurrence at follow-up one year later. Our observation supports the use of combination therapy in resistant cases of granuloma faciale. One such combination would be the application of a topical corticosteroid and tacrolimus followed by pulsed dye laser.
面部肉芽肿是一种罕见的炎症性皮肤病，通常累及面部，且往往对治疗有抵抗性。一名39岁的英国女性，Fitzpatrick皮肤光类型为II型，其脸颊和鼻子上出现了经活检确诊的典型面部肉芽肿病变。使用ScleroPlus脉冲染料激光（Candela公司，马萨诸塞州韦兰）治疗未见明显改善。5年后，患者因相同病变再次就诊，此时病变更加明显。外用莫米松未见改善，但加用外用他克莫司后病变明显变平。由于红斑和毛细血管扩张持续存在，再次尝试使用ScleroPlus脉冲染料激光治疗。首次治疗的波长为595nm，脉冲持续时间为1.5ms，光斑为7mm，能量密度为8.5J/cm²，随后两次治疗的能量密度为9.5J/cm²。治疗后病变完全消退，无瘢痕形成或色素改变。一年后的随访中无复发。我们的观察结果支持在面部肉芽肿的难治性病例中使用联合治疗。一种联合治疗方法是先外用糖皮质激素和他克莫司，然后进行脉冲染料激光治疗。
