[Study of the efficiency of carbon dioxide [CO2] laser for the treatment of rhinophyma]

Rhinophyma is a localized swelling of the soft tissue of the nose due to variable combinations of fibrosis, sebaceous hyperplasia and lymphoedema. It develops almost entirely in males. It is often regarded as a complication or end stage of rosacea. It may become grossly distorted in contour. The treatment of rhinophyma involves surgical removal of excess tissue or other means of physical ablation [1]. The primary reason for excision of rhinophyma is cosmetic deformity. Recently, carbon dioxide [CO2] laser has been advocated for the incomplete excision [vaporization] of rhinophyma followed by re-epithelialization from the remaining glandular epithelium [1, 2]. This study aims to evaluate the efficiency of CO2 laser for the treatment of rhinophyma, report the complications and follow-up the patients for a sufficient period. To our knowledge, it is the first to be done at Damascus University and in Syria. This study included 3 patients with moderate rhinophyma seen at Dermatology and Venereology Hospital at Damascus University during a period of two years between 19/2/2006-16/3/2008. A complete clinical history and examination were done for each patient, and the diagnosis of rhinophyma was made depending on the characteristic clinical feature. Patients underwent a single treatment session, and were followed-up for a sufficient period for reporting immediate and late complications, and to determine the degree of improvement of their cosmetic appearance and the recurrence rate. Vaporization of rhinophyma was done by using CO2 laser, 10600nm in the invisible far infrared range of electromagnetic spectrum of radiation. A continuous wave defocused and collimated beam of CO2 laser [spot size of 0.2mm] was used in a drilling mode by the free manual hand piece for the removal of the excess of tissue and remodeling of the nose, and in a scanning mode by the special hand piece of computerized pattern generator, which was used for doing skin resurfacing of the surface of the nose and feathering effect of its periphery at the end of the operation. All patients showed a very good or excellent result which consequently reflected in the improvement of their psychological status. No important complications were reported, and no obvious recurrence occurred after a follow-up period ranged between 1-18 months.. Using CO2 laser for the treatment of rhinophyma is greatly effective, and could be considered among the treatments of choice