A Systematic Review of Laser Treatment for Angiofibromas in Tuberous Sclerosis

Yaron Gu; Matthew J Verheyden; Deshan F Sebaratnam; Rose C Liu

doi:10.1097/DSS.0000000000004222

A Systematic Review of Laser Treatment for Angiofibromas in Tuberous Sclerosis

Dermatol Surg. 2024 May 9. doi: 10.1097/DSS.0000000000004222. Online ahead of print.

Authors

Yaron Gu^{1

2}, Matthew J Verheyden^{3

4}, Deshan F Sebaratnam^{1

2}, Rose C Liu⁴

Affiliations

¹ Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
² Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia.
³ Department of Dermatology, The Sutherland Hospital, Caringbah, New South Wales, Australia.
⁴ Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

PMID: 38728593
DOI: 10.1097/DSS.0000000000004222

Abstract

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.