Can We Use Laser Hair Removal to Prevent the Formation of Trichoepithelioma Lesions?

Sir, Trichoepithelioma (TE) is a rare benign hair follicle pluripotent germ cell tumor that mostly involves the face and scalp of adults. Most sporadic forms appear in 40-year-old adults or older.[1] Also, TEs may be associated with a familial genetic condition known as multiple familial trichoepithelioma (MFT). MFT is considerably rare and inherited in an autosomal dominant form with lessened expressivity and penetrance among males. MFT is characterized by multiple TEs on the inner eyebrows and nasolabial folds. Brooke-Spiegler syndrome mostly affects young women, and concurrent spiradenomas, TEs, and cylindromas may exist.[2] Histologically, TE shows an organoid growth outline of nests of basaloid cells with similar size and follicular differentiation surrounded by tumoral stroma that separates over the collagen into the upper reticular dermis. The fibromyxoid stroma of basaloid cell carcinoma (BCC) differs from the fibrous matrix of TE. Distinct histologic structures of TE consist of the presence of papillary mesenchymal bodies, which is rarely seen in keratotic BCC and hair bulb formation. TEs rarely metastasize. However, loss of the p53 tumor suppressor gene and raised signaling of phosphatidylinositol 3-kinase (PI3), protein kinase B (AKT) in tumor cells can result in transformation into trichoblastic carcinoma.[3] MFTs on the face make a huge cosmetic burden. The management of multiple facial TE lesions is challenging. Numerous ablative treatment modalities have been proposed for treating TEs such as surgical removal, CO2 laser, electrodesiccation, Erbium-doped yttrium-aluminum-garnet laser, and dermabrasion. Surgery is effective for solitary lesions; however, the consequence of scarring and poor cosmetic outcomes in cases with multiple lesions limits the usage of this method. Ablative laser irradiations have resulted in better outcomes in the treatment of both cutaneous and mucosal lesions since they have less pain and better recovery. However, all the suggested methods are insufficient for the management of multiple lesions and carry a noteworthy risk of erythema, edema, hyperpigmentation, scarring, and recurrences.[4] Topical therapy with imiquimod is a fairly suitable treatment with acceptable side effects and a high cure rate, mostly in cases with multiple lesions.[5] The mechanism of the hair removal laser is targeting melanin content in the hair shaft, follicular epithelium, and hair matrix by radiating special wavelengths of light usually between 600 and 1200 nm, that is selectively absorbed by melanin.[6] Therefore, we suggest using of hair removal laser to target the follicular structure and destroy the underlying mechanism of TE to prevent TE lesion formation. To increase the effect of hair removal lasers, we suggest prescribing topical minoxidil for the areas with vellus hair. Clinical experimental studies are needed to assess the practical advantage and effectiveness of this theory. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.