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الرحيم الرحمن الله بسمSudan University of Science and Technology

College of Postgraduate Studies

Evaluation of the Efficacy of Carbon Dioxide Laser in Treatment of Syringoma

BY:Dr. Huda Hassan Osman Dablouk

Supervisor:Dr. Faiz M.B. El ShafiaDr. Yousif Safi Eldin

June 2014

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The carbon dioxide laser became available in 1964 and soon became the most widely used laser in dermatologic practice. The carbon dioxide laser emits an invisible infrared beam at a 10,600-nm wavelength, targeting both intracellular and extracellular water. When light energy is absorbed by water-containing tissue, skin vaporization occurs with production of coagulative necrosis in the remaining dermis.

Background

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Syringoma is a benign sweat gland tumor, it is usually a symptomatic. It is more common in females than in males. The main reason for treatment is cosmetic mainly for syringomas of eyelids and cheeks. The name syringoma is derived from the Greek word syrinx, which means pipe or tube. Based on Friedman and Butler’s classification scheme, 4 variants of syringoma are recognized: (1) a localized form, (2) a form associated with Down syndrome, (3) a generalized form that encompasses multiple and eruptive syringomas, and (4) a familial form.

Background

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1. To evaluate the clinical efficacy of CO2 laser in the treatment of syringoma.

2. To determine clinical effectiveness and complications by direct observational photographs.

Study Objectives

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The study was done in the institute of laser Sudan-University of Science and Technology, Khartoum- Sudan in the period from May to October 2014.Ten patients were included in this study; all were females at age between 20 – 55 years. The range of sessions was between 1 – 3 sessions. The laser power was from 3.5 – 7 watt and duration time was 0.1 sec. Follow up was done every 2-3 weeks. The improvement was assessed according to the satisfaction of patients and estimating of the supervisor. Statistically it has been found that there was significant improvement.

Methods and Methodology

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Laser Operation:o The dose was adjusted according to the type of skin.

Characters of the lesions starting with test dose( according to literature) for 0.7 W then increase the dose gradually till reach the maximum dose 7 W.

o The exposure time was 0.1 sec. Single dose was given to the patient, but sometimes more than one according to the size of the lesion.

o Patients were followed every 2-3 weeks.

Methods and Methodology

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The number of sessions for seven patients ( 70%) was 2 sessions , for two patients (20%) was 1 session , and for one patient ( 10%) was 3 sessions .Three patients (30%) had side effect of the treatment as pain , oedema, and hypopigmentation. Two patients (20%) had pain and oedema. Five patients (50%) had pain , oedema , and hyperpigmentation .The response to the treatment for one patient (10%) was poor , for four patients (40%) was good , for two patients ( 20%) was very good , and for three patients (30%) was excellent .

Results

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Results

Table : Patients Age.

Percentage Frequency Age

40.00% 4 20 - 29

30.00% 3 30 – 39

10.00% 1 40-49

20.00% 2 50 - 59

100.00% 10 Total

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Results

Figure : Patients sex.

Male Female0.00%

20.00%40.00%60.00%80.00%

100.00%120.00%

0.00%

100.00%

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Results

Table : Site of the lesions.

Percentage Frequency Site of the lesions

80.00% 8Mixed ( peri-orbital+ Forehead+ Upperlip)

20.00% 2 Pure Forehead

100.00% 10 Total

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Results

Figure : Family History.

+ ve F.H -v.e F.H0.00%

20.00%

40.00%

60.00%

80.00%70.00

%

30.00%

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Results

Table : Severity of the lesions.

Percentage Frequency Severity of the lesions

10.00% 1 Mild

60.00% 6 Moderate

30.00% 3 Severe

100.00% 10 Total

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Results

Figure : Treatment received before.

Received Not received 0.00%

20.00%40.00%60.00%80.00%

100.00% 80.00%

20.00%

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Results

Table : Duration of the Disease.

Percentage Frequency Duration of the disease

10.00% 1 < 1 year

50.00% 5 1- 4 yrs

20.00% 2 5-10 yrs

20.00% 2 > 10 yrs

100.00% 10 Total

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Results

Figure : Number of Sessions.

1 sessions 2 sessions 3 sessions0.00%

20.00%

40.00%

60.00%

80.00%

20.00%

70.00%

10.00%

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Results

Table : Laser Power Used.

Percentage Frequency Laser Power Used

10.00% 1 3.5 and 5 watt

50.00% 5 5 watt only

10.00% 1 5 and 5.5 watt

10.00% 1 5.5 and 6 watt

10.00% 1 6 and 6.5 watt

10.00% 1 6 , 6.5 , and 7 watt

100.00% 10 Total

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Results

Figure : Side Effect of the Treatment.

0.00%

20.00%

40.00%

60.00%

30.00%20.00%

50.00%

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Results

Table : Response to the Treatment.

Percentage Frequency Response to the Treatment

40.00% 4 Good

30.00% 3 V. Good

30.00% 3 Excellent

100.00% 10 Total

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Figure : A comparison between syringoma before and after treatment with CO2 laser in a 41 years old female with Syringoma on the face.A: Before treatment.B: After 1 session with CO2 laser, power 3.5 W .C: After 2 sessions with CO2 laser, power 5 W. V. Good response of treatment.

A CB

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Figure : A comparison between syringoma before and after treatment with CO2 laser in a 55 years old female with Syringoma on the face.A: Before treatment.B: After 1 session with CO2 laser, power 5 W .C: After 2 sessions with CO2 laser, power 5.5 W. V. Good response of treatment.

A B C

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Figure : A comparison between syringoma before and after treatment with CO2 laser in a 21 years old female with Syringoma on the face.A: Before treatment.B: After 1 session with CO2 laser, power 5 W .V.Good response of treatment.

A B

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Figure : A comparison between syringoma before and after treatment with CO2 laser in a 21 years old female with Syringoma on the face.A: Before treatment.B: After 1 session with CO2 laser, power 5 W .Good response of treatment.

A B

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A B

C D

Figure : A comparison between syringoma before and after treatment with CO2 laser in a 35 years old female with Syringoma on the face.A: Before treatment.

B: After 1 session with CO2 laser, power 6 W .

C: After 2 session with CO2 laser, power 6.5 W .

D: After 3 session with CO2 laser, power 7 W .

Good response of treatment.

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Figure : A comparison between syringoma before and after treatment with CO2 laser in a 29 years old female with Syringoma on the face.A: Before treatment.B: After 1 session with CO2 laser, power 6 W .C: After 2 session with CO2 laser, power 6.5 W .Good response of treatment.

CBA

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Figure : A comparison between syringoma before and after treatment with CO2 laser in a 38 years old female with Syringoma on the face.A: Before treatment.B: After 1 session with CO2 laser, power 5 W .Excellent response of treatment.

A B

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Figure : A comparison between syringoma before and after treatment with CO2 laser in a 34 years old female with Syringoma on the face.A: Before treatment.B: After 1 session with CO2 laser, power 5 W .Excellent response of treatment.

A B

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Figure : A comparison between syringoma before and after treatment with CO2 laser in a 53 years old female with Syringoma on the face.A: Before treatment.B: After 1 session with CO2 laser, power 5.5 W .Good response of treatment.

A B

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From this study we can conclude that CO2 laser is efficient in the treatment of syringoma because there is remarkable reduction in the size and appearance of the lesions, and there were no scars . There is a rise in the family history records in syringoma. Early treatment of syringoma give excellent results. Forehead syringoma had an excellent result from one session and low dose only. Thus CO2 laser should be considered as a good and dependable alternative to other treatment techniques.

Conclusion

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o CO2 laser is recommended in the treatment of syringoma.

o Long study period is needed for good assessment of treatment and to give more time for follow up.

o There should be further future studies , comparative studies by large number of patients .

o Heat exposure should be minimized and the use of sun-block is the first step in syringoma prevention.

Recommendations

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Thanks