Case and Research Letter
Pulsed Dye Laser Treatment for Multiple Sebaceous Hyperplasia Secondary to Ciclosporin
Hiperplasias sebáceas múltiples secundarias a ciclosporina: tratamiento con láser de colorante pulsado
M.T. Truchuelo
, I. Allende, F.M. Almazán-Fernández, P. Boixeda
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Departamento de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Cuatro casos en la misma empresa" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1188 "Ancho" => 1583 "Tamanyo" => 284298 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Threebond sealant responsible for allergic contact dermatitis in our patients, 1 of whom had a vesicular reaction to the 2% Threebond solution.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Romaguera, J. Vilaplana, M. Llagostera, R. Grimalt" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Romaguera" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Vilaplana" ] 2 => array:2 [ "nombre" => "M." 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Truchuelo, I. Allende, F.M. Almazán-Fernández, P. Boixeda" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.T." "apellidos" => "Truchuelo" "email" => array:1 [ 0 => "maytetd@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Allende" ] 2 => array:2 [ "nombre" => "F.M." "apellidos" => "Almazán-Fernández" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Boixeda" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Departamento de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperplasias sebáceas múltiples secundarias a ciclosporina: tratamiento con láser de colorante pulsado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 938 "Ancho" => 1250 "Tamanyo" => 186192 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient 1 after treatment with pulsed dye laser. He continued with the immunosuppressive therapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ciclosporin is an immunosuppressive drug that has been associated with several secondary skin alterations. These include hair follicle changes (hypertrichosis, keratosis pilaris, acne, and folliculitis) and gingival hyperplasia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, very few cases of eruptive multiple sebaceous hyperplasia (MSH) secondary to ciclosporin have been reported. Among the possible therapies for MSH, treatment with CO<span class="elsevierStyleInf">2</span> ablative laser and pulsed dye laser (PDL) has been described on only a few occasions. We describe 2 cases treated with PDL, which has the advantage of offering excellent results with a better safety profile and greater patient comfort.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 41-year-old man with skin phototype IV had started immunosuppressive therapy with ciclosporin at a dose of 140 mg/d after undergoing liver transplant. A few months later he presented with a rash consisting of dozens of yellowish umbilicated papular lesions that were clinically and histologically compatible with MSH and remained unchanged months later though the dose of ciclosporin was halved. The lesions were mainly located on the forehead, cheeks, chin, and upper back (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). He received 3 sessions of PDL treatment (Cynergy Multiplex, Cynosure, Inc., Westford, MA) with a beam diameter of 5 mm, a pulse duration of 2 ms, and a fluence of 15 J/cm<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. On the larger lesions 2 passes were made with a 1-minute interval between pulses. Continuous airflow cooling (Cryo5 Zimmer Medizinsysteme GmbH, Neu-Ulm, Germany) was applied at maximum level. A complete response was obtained in more than 75% of the lesions and a partial response in the rest. No crusting, blistering, or secondary pigmentary changes developed. The patient only presented minimal atrophic scarring. We found no recurrence of the treated lesions at the 6-month follow-up despite continuing treatment with ciclosporin at a dose of 75 mg/d (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second case was a 41-year-old man with skin phototype II-III treated with immunosuppressive therapy using ciclosporin at a dose of 150 mg/d after kidney transplantation, who had lesions similar in appearance and distribution to those of the previous case. A diagnosis of MSH was made, and he received treatment with PDL in 2 sessions, using identical parameters to those of the previous case. The response was very good, with total disappearance of more than 75% of the lesions and no associated adverse effects. The remission persisted 4 months after treatment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">MSH is a benign proliferation of the sebaceous glands that in most cases is idiopathic and affects the elderly. However, it has been observed in patients treated with systemic corticosteroids, on hemodialysis, and in conditions such as Torre syndrome, X-linked hypohidrotic ectodermal dysplasia syndrome, and pachydermoperiostosis. In some cases reported in the literature, the authors suggest a possible association with ciclosporin.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although the lesions are benign, they may have major cosmetic and psychological effects on the patients because they are located mainly in the facial region. It is therefore very important to eradicate them. The treatment options traditionally used include surgical excision, curettage, cryotherapy, cautery, and CO<span class="elsevierStyleInf">2</span> laser, all of which are aggressive and involve a high risk of scarring and pigmentary changes. Photodynamic therapy using PDL, intense pulsed light, and red or blue light-emitting diodes has also been used recently with good results.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> The advantage of these procedures is that they avoid post-treatment purpura; the disadvantages are greater pain and higher cost, and possibly the need for a greater number of sessions to obtain results.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> PDL has recently been described in the successful treatment of sebaceous hyperplasia and of other multiple and benign skin lesions, such as xanthelasma, angiofibromas, and molluscum contagiosum.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> PDL eliminates MSH quickly, easily, and painlessly (without anesthesia) and only involves a transient purpuric effect. It therefore avoids the risks of the traditional techniques described above. Most lesions disappear after a single treatment. The effect of PDL could be explained by its selective action on the telangiectatic component of the lesion, leading to destruction of the vessels that nourish the sebaceous hyperplasia. This treatment was recently described with in vivo confocal microscopy imaging before and after treatment with PDL, showing that a few minutes after application of the beam the vessels surrounding the sebaceous duct were replaced by amorphous and coagulated material.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, PDL is a fast, painless, well-tolerated, and safe therapeutic option for the treatment of MSH.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Truchuelo M. T, et al. Hiperplasias sebáceas múltiples secundarias a ciclosporina: tratamiento con láser de colorante pulsado. Actas Dermosifiliogr.2011;102:470-471.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 938 "Ancho" => 1250 "Tamanyo" => 213468 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient 1, showing facial multiple sebaceous hyperplasia secondary to maintenance immunosuppressive therapy using ciclosporin.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 938 "Ancho" => 1250 "Tamanyo" => 186192 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient 1 after treatment with pulsed dye laser. 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Raulin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med" "fecha" => "1997" "volumen" => "21" "paginaInicial" => "313" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9328977" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of xanthelasma palpebrarum with the pulsed dye laser" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.P. Schönermark" 1 => "C. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 12 | 24 |
| 2024 Octubre | 99 | 54 | 153 |
| 2024 Septiembre | 121 | 41 | 162 |
| 2024 Agosto | 134 | 79 | 213 |
| 2024 Julio | 113 | 70 | 183 |
| 2024 Junio | 98 | 49 | 147 |
| 2024 Mayo | 136 | 50 | 186 |
| 2024 Abril | 123 | 26 | 149 |
| 2024 Marzo | 135 | 52 | 187 |
| 2024 Febrero | 118 | 50 | 168 |
| 2024 Enero | 115 | 46 | 161 |
| 2023 Diciembre | 101 | 36 | 137 |
| 2023 Noviembre | 156 | 37 | 193 |
| 2023 Octubre | 105 | 42 | 147 |
| 2023 Septiembre | 128 | 49 | 177 |
| 2023 Agosto | 97 | 38 | 135 |
| 2023 Julio | 136 | 47 | 183 |
| 2023 Junio | 93 | 27 | 120 |
| 2023 Mayo | 139 | 42 | 181 |
| 2023 Abril | 91 | 31 | 122 |
| 2023 Marzo | 90 | 26 | 116 |
| 2023 Febrero | 83 | 26 | 109 |
| 2023 Enero | 58 | 41 | 99 |
| 2022 Diciembre | 54 | 44 | 98 |
| 2022 Noviembre | 30 | 30 | 60 |
| 2022 Octubre | 55 | 30 | 85 |
| 2022 Septiembre | 77 | 27 | 104 |
| 2022 Agosto | 88 | 35 | 123 |
| 2022 Julio | 115 | 42 | 157 |
| 2022 Junio | 102 | 31 | 133 |
| 2022 Mayo | 95 | 38 | 133 |
| 2022 Abril | 69 | 34 | 103 |
| 2022 Marzo | 95 | 47 | 142 |
| 2022 Febrero | 75 | 36 | 111 |
| 2022 Enero | 131 | 33 | 164 |
| 2021 Diciembre | 73 | 39 | 112 |
| 2021 Noviembre | 81 | 50 | 131 |
| 2021 Octubre | 115 | 52 | 167 |
| 2021 Septiembre | 84 | 44 | 128 |
| 2021 Agosto | 76 | 33 | 109 |
| 2021 Julio | 76 | 32 | 108 |
| 2021 Junio | 71 | 36 | 107 |
| 2021 Mayo | 61 | 37 | 98 |
| 2021 Abril | 97 | 58 | 155 |
| 2021 Marzo | 106 | 32 | 138 |
| 2021 Febrero | 80 | 36 | 116 |
| 2021 Enero | 79 | 19 | 98 |
| 2020 Diciembre | 62 | 15 | 77 |
| 2020 Noviembre | 38 | 10 | 48 |
| 2020 Octubre | 63 | 8 | 71 |
| 2020 Septiembre | 44 | 17 | 61 |
| 2020 Agosto | 33 | 17 | 50 |
| 2020 Julio | 24 | 19 | 43 |
| 2020 Junio | 45 | 29 | 74 |
| 2020 Mayo | 24 | 25 | 49 |
| 2020 Abril | 22 | 14 | 36 |
| 2020 Marzo | 26 | 18 | 44 |
| 2020 Febrero | 5 | 2 | 7 |
| 2020 Enero | 0 | 13 | 13 |
| 2019 Diciembre | 2 | 1 | 3 |
| 2019 Noviembre | 0 | 3 | 3 |
| 2019 Octubre | 0 | 5 | 5 |
| 2019 Septiembre | 4 | 5 | 9 |
| 2019 Agosto | 0 | 8 | 8 |
| 2019 Julio | 0 | 10 | 10 |
| 2019 Junio | 2 | 17 | 19 |
| 2019 Mayo | 0 | 32 | 32 |
| 2019 Abril | 0 | 36 | 36 |
| 2019 Marzo | 2 | 13 | 15 |
| 2019 Febrero | 0 | 4 | 4 |
| 2019 Enero | 2 | 4 | 6 |
| 2018 Diciembre | 2 | 4 | 6 |
| 2018 Noviembre | 0 | 3 | 3 |
| 2018 Octubre | 1 | 5 | 6 |
| 2018 Septiembre | 2 | 4 | 6 |
| 2018 Agosto | 0 | 1 | 1 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Junio | 0 | 3 | 3 |
| 2018 Mayo | 0 | 8 | 8 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 3 | 3 | 6 |
| 2018 Febrero | 70 | 11 | 81 |
| 2018 Enero | 108 | 9 | 117 |
| 2017 Diciembre | 105 | 10 | 115 |
| 2017 Noviembre | 83 | 13 | 96 |
| 2017 Octubre | 92 | 8 | 100 |
| 2017 Septiembre | 104 | 17 | 121 |
| 2017 Agosto | 133 | 16 | 149 |
| 2017 Julio | 123 | 21 | 144 |
| 2017 Junio | 147 | 16 | 163 |
| 2017 Mayo | 133 | 29 | 162 |
| 2017 Abril | 173 | 13 | 186 |
| 2017 Marzo | 110 | 35 | 145 |
| 2017 Febrero | 63 | 15 | 78 |
| 2017 Enero | 71 | 20 | 91 |
| 2016 Diciembre | 98 | 15 | 113 |
| 2016 Noviembre | 159 | 17 | 176 |
| 2016 Octubre | 171 | 29 | 200 |
| 2016 Septiembre | 143 | 15 | 158 |
| 2016 Agosto | 89 | 25 | 114 |
| 2016 Julio | 83 | 10 | 93 |
| 2016 Junio | 10 | 18 | 28 |
| 2016 Mayo | 8 | 12 | 20 |
| 2016 Abril | 5 | 2 | 7 |
| 2016 Marzo | 8 | 19 | 27 |
| 2016 Febrero | 11 | 1 | 12 |
| 2016 Enero | 7 | 1 | 8 |
| 2015 Diciembre | 7 | 3 | 10 |
| 2015 Noviembre | 27 | 5 | 32 |
| 2015 Octubre | 30 | 1 | 31 |
| 2015 Septiembre | 18 | 1 | 19 |
| 2015 Agosto | 16 | 1 | 17 |
| 2015 Julio | 62 | 12 | 74 |
| 2015 Junio | 86 | 15 | 101 |
| 2015 Mayo | 128 | 28 | 156 |
| 2015 Abril | 151 | 20 | 171 |
| 2015 Marzo | 148 | 12 | 160 |
| 2015 Febrero | 118 | 24 | 142 |
| 2015 Enero | 80 | 19 | 99 |
| 2014 Diciembre | 107 | 21 | 128 |
| 2014 Noviembre | 83 | 13 | 96 |
| 2014 Octubre | 97 | 20 | 117 |
| 2014 Septiembre | 100 | 17 | 117 |
| 2014 Agosto | 112 | 18 | 130 |
| 2014 Julio | 113 | 19 | 132 |
| 2014 Junio | 119 | 14 | 133 |
| 2014 Mayo | 144 | 17 | 161 |
| 2014 Abril | 123 | 12 | 135 |
| 2014 Marzo | 137 | 25 | 162 |
| 2014 Febrero | 109 | 20 | 129 |
| 2014 Enero | 115 | 24 | 139 |
| 2013 Diciembre | 109 | 24 | 133 |
| 2013 Noviembre | 60 | 20 | 80 |
| 2013 Octubre | 47 | 26 | 73 |
| 2013 Septiembre | 45 | 24 | 69 |
| 2013 Agosto | 54 | 21 | 75 |
| 2013 Julio | 55 | 39 | 94 |
| 2013 Junio | 12 | 25 | 37 |
| 2013 Mayo | 17 | 22 | 39 |
| 2013 Abril | 15 | 21 | 36 |
| 2013 Marzo | 16 | 15 | 31 |
| 2013 Febrero | 48 | 12 | 60 |
| 2013 Enero | 62 | 13 | 75 |
| 2012 Diciembre | 25 | 6 | 31 |
| 2012 Noviembre | 1 | 2 | 3 |
| 2012 Octubre | 2 | 3 | 5 |
| 2012 Septiembre | 0 | 2 | 2 |
| 2012 Agosto | 0 | 1 | 1 |
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