Treatment of Dowling-Degos disease with fractional Er:YAG laser

Abstract

Dowling-Degos disease (DDD) is a rare, benign, autosomal dominant disorder characterized by reticulated pigmentation on flexural areas. Recently, a report of successful Er:YAG ablative laser treatment without any adverse effects was issued. A 49-year-old Korean woman presented with numerous small, hyperpigmented macules in a reticular pattern on her face, axillae, and inguinal folds of several years duration. Histologic examination revealed acanthosis with thin elongated rete ridges, basal branching, and widening. She was diagnosed as having DDD and was treated successfully without any adverse effects using a fractional 2,940-nm Er:YAG ablative laser (LOTUSII, Laseroptek, Sungnam, Korea). Er:YAG ablative laser treatment could be an effective treatment modality for DDD, but in Asians, who have darker skins than Caucasians, or in patients with skin lesions on the face, post-inflammatory hyperpigmentation could be problematic after treatment. Fractional Er:YAG ablative laser treatment should be viewed as an alternative therapeutic option for DDD.

Updated review of genetic reticulate pigmentary disorders

“…However, the potential risks of postlaser hyperpigmentation in Asians (who have relatively darker skin) and patients with facial lesions are still a concern. Another study reported that using a fractional Er:YAG laser led to improvement of pigmentation in facial lesions of an Asian patient with DDD and was effective in reducing postoperative inflammation but could not produce the therapeutic results of an ablative approach . Recently, one case report showed that the pigmentation of lentigines in patients with DDD could be treated successfully using intense pulsed light, suggesting an alternative option for pigmented lesions in DDD …”

Successful treatment of Dowling‐Degos disease using intense pulsed light

“…While a fractional technique allows rapid re-epithelialisation and reduces inflammation, the sparing of tissue around microthermal treatment zones limits its efficacy. 5 We chose to trial IPL to treat the lentigines in this patient with DDD due to its excellent safety profile and established efficacy in the treatment of pigmented lesions. The good therapeutic results and minimal adverse effects seen here after treatment with IPL are likely to be due to selective photothermolysis.…”

“…1,2 No treatment modality has yet been established as a definitive method for the effective elimination of lentigines in DDD. 5 While this was effective in reducing postoperative inflammation, the authors acknowledged that this latter method could not produce the therapeutic results of an ablative approach. 1,3 There have been case reports using laser treatment to remove the abnormal epidermal tissue in DDD.…”

“…Yun and colleagues then described the use of fractional Er:YAG in a woman with dark, Asian skin, with the aim of reducing the risk of postinflammatory hyperpigmentation. 5 While this was effective in reducing postoperative inflammation, the authors acknowledged that this latter method could not produce the therapeutic results of an ablative approach.…”

Successful management of dowling-degos disease with combination of Q-switched Nd: YAG and fractional carbon dioxide laser

“…Various lasers especially Erbium YAG and fractional Erbium YAG have been beneficial in treating DDD. [45]…”