Microcystic lymphatic malformations (lymphangioma circumscriptum) managed with fractional carbon dioxide laser ablation

Microcystic lymphatic malformation (lymphangioma circumscriptum) is the most common cutaneous lymphatic malformation, consisting of abnormal, dilated, and tortuous lymphatic vessels in the dermis and subcutaneous tissue. It is due to irregular vessel contraction with subsequent dilatation and fluid build-up that manifests clinically as multiple, grouped, small macroscopic superficial vesicles filled with clear or serosanguineous fluid. The lesions are frequently located over proximal limbs, axillae and chest but may occur on any part of the body. We report a case of lymphangioma circumscriptumin a four-year-old child, partially treated with fractional carbon dioxide laser ablation under local anesthesia. Most of the lesions resolved but the treated areas healed with hypertrophic scarring after one month, which was cosmetically acceptable. Compared to surgical excision, carbon dioxide laser ablation may provide less chances of contractures especially in areas overlying a joint and may be considered as an alternative to more invasive procedures.

Porokeratosis of Mibelli: A case report

Porokeratosis is a genodermatosis characterized by abnormal epidermal keratinization with the histologic finding of cornoid lamella. Porokeratosis of Mibelli may be autosomal dominant or sporadic. Currently, there is no established cure for this disease and few clinical trials have been published worldwide. We describe a case of a 56-year-old man with a seventeen year history of a solitary erythematous plaque with raised border along the left midaxillary line, originating from a papule which was burned by a cigarette. Review of skin punch biopsy which was initially read as keloid with signs of irritation showed columns of parakeratosis with underlying necrotic keratinocytes, consistent with porokeratosis. Topical 4% 5-fluorouracil in propylene glycol was applied twice daily which resulted in an inflammatory response after 3 weeks of use. This gradually resolved with notable decreased thickness of the plaque.