Carbon dioxide laser treatment for Darier disease

Carbon dioxide laser treatment for Darier diseaseTo the Editor: Darier disease is a chronic disease that can significantly impair quality of life due to discomfort, malodor, and disfigurement from the thick, hyperkeratotic plaques. [1][2]2][3][4] Treatment options are limited with varying success.Oral retinoids have been considered the standard treatment for Darier disease but may be contraindicated or ineffective. [1][2]][3][4] In this study, we evaluated the utility of carbon dioxide (CO 2 ) laser as a treatment modality for Darier disease.A retrospective case series was performed of 12 patients with Darier disease who were treated with CO 2 laser at Mayo Clinic, Rochester, MN.Weck 525 CO 2 Surgical Laser (Weck Instruments, Inc) or Lumenis UltraPulse CO 2 (Lumenis, Inc) was used.Settings varied by treatment; in most cases a 125mm handpiece was used in defocused fashion in continuous wave mode, with power ranging from 10 to 60 watts and between 1 and 4 passes (Table I).Gentle curettage was used between passes with an endpoint of yellow-white, firm, dermal tissue.Among the 12 cases, a total of 21 treatments were performed; 19 were ablative and 2 were fractionated.Average age at treatment was 47 years (range 18-76, SD 17).Nine patients had disease refractory to oral retinoids.Anesthesia included local only (n 8), local with conscious sedation (n 7), and general anesthesia (n 6).Average body surface area treated per procedure was 320 cm 2 (range 18-1528, SD 342).Sites included extremities (n 9), buttocks (n 8), trunk (n 8), face (n 8), and intertriginous areas (n 5).Persistent or recurrent disease occurred after treatment for 2 cases.For one case, fractionated laser was used over the forehead with recurrence, but after changing to ablative laser with deeper dermal penetration, there was no recurrence.For the second, ablative settings were used on the legs, but the patient was lost to follow up for 13 years and had significant disease requiring grafting, limiting assessment.For the other 18 treatments among the remaining 10 cases, no recurrence occurred in treated areas.There was 1 case in which there was new, mild activity to the periphery