A Systematic Review of Laser Treatment for Angiofibromas in Tuberous Sclerosis
Yaron Gu1,2, Matthew J Verheyden3,4, Deshan F Sebaratnam1,2
1Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
Background:
While mammalian target of rapamycin inhibitors have revolutionized the management of angiofibroma in tuberous sclerosis complex (TS), physical modalities such as laser are still indicated for recalcitrant lesions.
Objective:
The authors performed a systematic review of the efficacy and safety of laser treatment for TS-related facial angiofibroma.
Methods:
The electronic databases such as MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to October 10, 2023, for eligible records.
Results:
Forty-seven articles met the inclusion criteria, representing a total of 217 patients with TS-related facial angiofibroma who received laser treatment. Several lasers have been trialed in patients including carbon dioxide ( n = 95, 43.7%), pulsed dye ( n = 21, 9.7%), argon ( n = 16, 7.4%), neodymium-doped: yttrium aluminum garnet ( n = 12, 5.5%), copper vapor ( n = 9, 4.1%), potassium titanyl phosphate ( n = 7, 3.2%), erbium: yttrium aluminum garnet ( n = 2, 0.9%), lasers and various combination therapies ( n = 55, 25.3%).
Conclusion:
Potassium titanyl phosphate, pulsed dye, and neodymium-dopsed:yttrium aluminum garnet lasers are better suited to manage the vascular components of angiofibroma while ablative lasers such as erbium: yttrium aluminum garnet and carbon dioxide lasers may present better options for lesions with a prominent fibrous component. While several lasers have been trialed with broadly favorable results, the low level of evidence precludes definitive conclusions, and no single laser appears superior.
Insights
Laser treatments show promise for facial angiofibroma in tuberous sclerosis complex (TS). Various lasers are effective, but evidence is limited, and no single option is definitively superior for managing these TS-related lesions.
Area of Science:
- Dermatology
- Oncology
- Medical Aesthetics
Background:
- Facial angiofibromas are a common manifestation of tuberous sclerosis complex (TS).
- Mammalian target of rapamycin (mTOR) inhibitors have improved management, but recalcitrant lesions often require physical modalities.
- Laser therapy is a key physical modality for treating persistent angiofibromas in TS patients.
Conclusions:
- Laser treatments offer broadly favorable results for facial angiofibroma in TS.
- Different lasers are suited for vascular or fibrous components of angiofibromas.
- The current low level of evidence prevents definitive conclusions on laser superiority.
