Split-face comparative case series of intralesional radiofrequency ablation and carbon dioxide laser pinhole ablation for syringoma

Syringomas are benign adnexal tumors originating from the intraepidermal part of eccrine glands, commonly appearing as skin-colored papules in the periorbital region. These lesions are usually asymptomatic, cosmetic concerns being more prominent. Among various treatment modalities, intralesional radiofrequency ablation and carbon dioxide (CO2) laser pinhole ablation are well-established treatments. This study aimed to compare the efficacy of these two techniques in a split-face manner. To minimize adverse events and downtime, intralesional radiofrequency (RF) on the one side and CO2 laser on the other side were performed. Since RF was applied only to the lesion’s center, the CO2 laser was also limited to pinhole ablation with conservative parameters. Five female patients aged 23–57 years with syringoma underwent treatment, with the left side of the face receiving intralesional radiofrequency ablation and the right side undergoing CO2 laser pinhole ablation. Post-procedure, lesion reduction was assessed after 1 month using lesion count, the Global Improvement Scale, and the Patient Satisfaction Scale. Results showed that intralesional radiofrequency ablation led to an average reduction of 41% in lesion count, compared to 10.3% with CO2 laser pinhole ablation. In comparison to CO2 laser pinhole ablation of the syringoma, intralesional RF ablation with an insulated insulin needle stands to be a more efficient treatment at a much lesser cost. However, careful patient selection based on skin type should be done.