Comparison of microinsulated needle radiofrequency and carbon dioxide laser ablation for the treatment of syringoma

Abstract

Syringoma is a benign adnexal tumor originating from the intradermal eccrine ducts and predominantly occurs in women at puberty or later in life. We present a case of a 30‐year‐old woman with a 2‐year history of syringoma on her neck and axillar region. She was treated with two devices in a split manner. The right‐sided lesions of the neck were treated with one session of 10,600‐nm carbon dioxide (CO2) laser ablation. The left‐sided lesions were treated with microinsulated needle radiofrequency (RF) three times. After treatment, the lesions treated with CO2 showed hypertrophic scar formation, but the other side lesions treated with microinsulated needle RF showed a marked reduction in the size and number of lesions, without any adverse effects such as scarring and hyperpigmentation related to epidermal damage. The treatment of syringoma with microinsulated needle RF, which is insulated at the point of epidermal contact, results in good cosmetic outcomes. Syringoma, microinsulated needle RF, CO2 laser.

Clinical characteristics and pathological depths of syringomas in 94 Korean patients

“…Microneedle RF technique has been investigated in diverse fields such as minimally invasive transdermal drug delivery, skin rejuvenation, and treatment of various skin problems (androgenetic alopecia, melasma, acne vulgaris, and scar) as reviewed by Ramaut et al 7 Microneedle RF has advantage of bypassing epidermis, hence minimizes the epidermal damage, and selectively targets the dermal lesion. Bae et al 4 reported treatment for syringoma with microinsulated needle RF, which showed a significant reduction in the size and number of lesions with lesser adverse event of scarring and hyperpigmentation regard of epidermal damage compared to CO 2 ablation.…”

“…However, for the cosmetic purpose, laser treatment, trichloroacetic acid, and topical agents such as retinoids are used 2,3 . Even though laser ablation with CO 2 laser or Er:YAG laser is thought to be choice of treatment for the syringoma, no consensus has been reached for the specific value for the laser setting, and adverse events like cutaneous scarring are common after the ablative laser treatment 4 …”

Botulinum toxin A as monotherapy for syringoma

“…Other reports include a combination of treatments with trichloroacetic acid and CO 2 laser, 6 temporary tattooing with Q-switched alexandrite laser and CO 2 laser in vaporization mode, 7 a combination of carbon dioxide laser with Botulinum Toxin A, 8 and needle radiofrequency. 9 Other treatments reported are ablation with intralesional insulated needles. 10 The exact mechanism of how BTX-A works on syringomas is unknown 8 ; it could be explained by the blockade of the cholinergic terminals by the inhibition of the SNAP-25 (synaptosome-associated protein of 25 kd) of the SNARE complex, therefore inhibiting the release of acetylcholine from cytoplasmic vesicles of the nerve ending.…”

“…Kim et al 1 reported a clinical improvement with a 1444 nm Neodymium‐Doped Yttrium Aluminum laser; Wheeland et al 3 used CO 2 , Erbium YAG laser, 4 and fractional photothermolysis, 5 which also had been mentioned as a successful monotherapy. Other reports include a combination of treatments with trichloroacetic acid and CO 2 laser, 6 temporary tattooing with Q‐switched alexandrite laser and CO 2 laser in vaporization mode, 7 a combination of carbon dioxide laser with Botulinum Toxin A, 8 and needle radiofrequency 9 . Other treatments reported are ablation with intralesional insulated needles 10 …”

Pinhole technique for cobblestoning in patients post mini-punch grafting for stable vitiligo

“…3 The edema and erythema post-RF may persist upto two weeks, thus having longer downtime than CO 2 laser. 4 Moreover, RF can result in undesired fat atrophy by heating the subcutaneous fat. This can be prevented using CO 2 laser, where the amount of destruction and depth of penetration is time dependent.…”