Fractional Carbon Dioxide Laser for the Treatment of Microstomia in Limited-Cutaneous Systemic Sclerosis

Limited-cutaneous systemic sclerosis (lcSSc), formerly known as CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, scleroderma, and telangiectasias) is an auto-immune connective tissue disease characterized by cutaneous fibrosis and systemic fibrovascular dysfunction. The cutaneous fibrosis of lcSSc is commonly limited to acral sites, with perioral involvement seen in 70%-85% of cases. Patients often seek treatment of lcSSc-associated microstomia for functional and cosmetic purposes. Treatments for the cutaneous sclerosis in systemic sclerosis (SSc) include topical agents, systemic immunosuppressants, phototherapy, and other less commonly used systemic medications. More recently fractional ablative laser therapy with the carbon dioxide (CO₂) laser has been utilized in scarring disorders of the skin with notable improvement in cutaneous fibrosis. Here we report a case of a 54-year-old female with lcSSc-associated microstomia treated with fractional ablative CO₂ laser. The goal of treatment was to improve the objective size of the oral aperture and improve subjective symptoms, including oral mobility, speech, and eating.

The Lumenis Ultra Pulse CO₂ laser was used to fractionally ablate the target peri-oral skin. Pulses were performed up to but not crossing the vermillion border circumferentially around the mouth. Measurements in centimeters were taken pretreatment as well as 2 and 5 months posttreatment. Appropriate infectious prophylaxis was provided to the patient.

Notable increases were observed at 2 and 5 months follow-ups in horizontal width (+14.3%), vertical height (+12.1%), and cross-sectional areas (+28.1%) of the oral aperture following a single treatment with CO₂ laser. Subjective improvements in oral mobility, speech, and daily activities such as eating were noted by the patient.

Ablative fractional CO₂ laser is an effective and efficient method for the treatment of microstomia secondary to systemic sclerosis with minimal adverse effects. Utilizing this therapeutic treatment can significantly impact the quality of life in patients with lcSSc-associated microstomia.