Severe rhinophyma treated with double wavelengths carbon dioxide‐GaAs laser: a case series

Severe rhinophyma treated with double wavelengths carbon dioxide-GaAs laser: a case series Dear Editor, Rhinophyma is a disfiguring condition of the nose characterized by hyperplasia of the sebaceous glands and dermal tissue, which usually represents the final stage of rosacea. Other variants including gnatophyma (chin), metophyma (forehead), otophyma (ear), and blepharophyma (eyelids) are rarely seen. Many different treatment modalities for rhinophyma have been utilized both alone and in combination including: traditional excision, cryotherapy, dermabrasion, electrosurgery, CO2 laser, diode, and Er:Yag laser ablation, but as yet there is no agreement in the literature on the ideal treatment. Rhinophyma consists of a slow, progressive thickening of the nasal skin and soft-tissue hypertrophy which may result in localized or generalized tuberous deformity of the lower twothirds of the nose. Rhinophyma is a benign condition, but the nasal deformation may severely affect both cosmetic and psychological aspects. We report four retrospective cases of mildsevere rhinophyma (range 58–85 years old) successfully treated with laser vaporization combining two different wavelengths: carbon dioxide (CO2) 10,600 nm and GaAs 1,540 nm. In two patients (Fig. 1a–c), oral therapy with tetracyclines and subsequent oral isotretinoin (0.5–1 mg/kg/die) for 6 months were effective in controlling inflammation episodes, but relapses were observed 6 months after suspension. The patients were scheduled for laser vaporization with a double-wavelength device (Youlaser MT apparatus, Quanta System, Solbiate Olona, Italy) emitting 10,600 nm and 1,540 nm wavelengths simultaneously. All informed consents were obtained. Troncular and local anesthesia were performed with bupivacaine + adrenaline (1:200.000). All patients underwent a single laser session using 1 mm spot size and 8 msec pulse delay, 8 W power at 2 msec pulse duration, and 10 W power at 0,25 msec pulse duration, respectively, for wavelengths 1,540 nm and 10,600 nm. During the treatment, the necrotic tissue was removed with a saline solution wet gauze, and we