Recurrent granuloma faciale successfully treated with the carbon dioxide laser.

Sir,

Despite evaluation of a plethora of modalities, treatment of Granuloma Faciale (GF) remains disappointing. Search for an effective, low-risk treatment led to the use of Pulsed Dye Laser (PDL) in GF with variable results.[12] In a recent series assessing the role of PDL in GF, Cheung and Lanigan noted a significant cosmetic improvement in two of their four patients.[1] Cosmetic improvement was maintained for at least 12 months in one patient. Here we report a patient in whom GF relapsed two years after it had partially responded to a series of PDL treatments and its subsequent response to the carbon dioxide (CO2) laser.

A 51-year-old man with biopsy proven GF of the right cheek that had failed to respond to topical corticosteroids and cryotherapy underwent five PDL treatments at two-month intervals (Candela ScleroPLUS, 8-10 J/cm2, 585 nm, 7-mm spot, 1.5 msec, dynamic cooling device 30 msec spray, 30 msec delay) between 2000 and 2002. This resulted in a partial cosmetic improvement, which was not sustained beyond two years [Figure 1]. A series of 16 PDL treatments (Candela V Beam Perfecta, 10-12 J/cm2, 595 nm, 7-mm spot, 1.5 msec, dynamic cooling device 30 msec spray, 30 msec delay) at two-month intervals were ineffective in bringing about any improvement. He was offered two treatments with the CO2 laser spaced at three-month intervals (Sharplan 40 C CO2 laser, silk touch mode using a scanner device, 4-mm spot size, 12W, 4 passes to the papillary dermis). This resulted in an excellent cosmetic improvement, which has been maintained for 3 years [Figure 2]. Although it is difficult to predict the response in the longer time, our experience of treating other dermatoses with the CO2 laser makes it likely that this response will be sustained.[3]

Figure 1

Pulsed dye laser recurrent granuloma faciale. Note the hypopigmentation as a result of previous treatments

Figure 2

Three years post CO2 laser treatment

Destructive lasers have been used in the treatment of GF with variable results. One of the main concerns has been the risk of scarring associated with the use of CO2 laser.[4] The use of scanner-assisted CO2 laser as seen in our case is safer and helps circumvent this problem.