Keratosis Pilaris Atrophicans Faciei: A Case Treated with 585 nm Diode Laser, a Novel Fractional Solid-State

Introduction

Keratosis pilaris atrophicans faciei (KPAF), in other saying ulerythema ophryogenes, is a rare, hereditary, follicular disorder categorized in the atrophicans subtypes of keratosis pilaris (KP). It is mostly seen in children and adolescents and it can persist through adulthood. It’s mechanism is complicated and not yet clearly understood.¹ Genetically, autosomal dominant and autosomal recessive inheritance have been identified.² Keratinization and inflammation become in the follicles and then atrophy occurs. On physical examination, it can be seen follicular, horny papules with an erythematous halo of the cheeks, forehead, chin and eyebrows, and a gradual loss of hair begins.³ There are different treatment models but an effective treatment method has not yet been found.⁴ Here, we present a case with KPAF treated with 585 nm diode laser, a novel fractional laser system with differential wavelength modified optically pumped semiconductor (D-WMOPS) technology.

Case Report

A 29-year-old male with KPAF applied to dermatology outpatient clinic of University of Health Sciences, Izmir Tepecik Training and Research Hospital. Clinically, there were follicular, horny and erythematous papules on his beard area, especially along the beard border line on his cheeks (Figures 1–5). He had the pathology report of another hospital supporting the diagnosis as KPAF. He used tretinoin cream, urea 40% cream, oral isotretinoin and acitretin for treatment but all these methods did not work. We suggested 585 nm diode laser treatment for the patient. In the first session, laser therapy was performed using a fluence of 5 w, a pulse duration of 20 ms, a spot size of 1.2 mm for cheeks and 5 w, 22 ms, 1.2 mm for ears, and then at from second to fifth sessions a fluence of 5 w, a pulse duration of 20 ms, a spot size of 1.2 mm for all areas one month apart. After 5 months we observed significant improvement at all areas with lesions from our point of view (Figures 1–5). Laser treatment of the case continues monthly. Mild erythema may occur after each session as side effect. The authors obtained written consent from patient for their photographs and medical information to be published in print and online and with the understanding that this information may be publicly available. Patient consent form was not provided to the journal but is retained by the authors. İzmir Tepecik Training and Research Hospital’s approval was required and provided to publish the case details.

Figure 1 Right side of face.

Figure 2 Left side of face.

Figure 3 Right side of face crossed, front view.

Figure 4 Left side of face crossed, front view.

Figure 5 Full face.

Discussion

A novel fractional laser system with D-WMOPS technology can produce a pure 585 nm wavelength as pulsed dye laser (PDL), which has been used to treat vascular and pigmented skin lesions. PDLs use the high peak power and the sudden burst of short pulses and therefore they may break down the vessel walls with subsequent purpura. This novel fractional 585 nm diode laser with D-WMOPS technology can produce a pure 585 nm wavelength under a “steady-state” thermal condition and slowly heat the target. In PDLs, the risk of postinflammatory hyperpigmentation raises in darker skin phototype although purpura is considered a therapeutic endpoint in PDL treatment. The 585 nm diode laser with D-WMOPS technology heats the vessels gently and steady therefore this technology would be more acceptable for sensitive areas cosmetically such as face. Pain is tolerable and no purpura appears at the treatment areas. If all this data is considered, this new laser technology has various advantages than conventional PDL.⁵ Nowadays KP and its subtypes can be treated with light and laser devices that are therapeutic options for different skin diseases.⁶ Laser treatment (PDL) was used firstly by Clark et al for KPAF with 12 cases in 2000. Since then, laser treatments have been considered as important options among all therapeutic options for KP, keratosis pilaris rubra (KPR), and KPAF.⁷ In the literature, PDL, intense pulsed light and carbon dioxide laser were used for KPAF treatment.⁶ Lasers with wavelengths <600 nm, especially PDL that used in a case report, two case series, and a prospective cohort study, are effective for treatments of KPR and keratosis pilaris atrophicans (KPA) including KPAF.⁸ We did not determined any cases with KPAF treated with 585 nm diode laser with D-WMOPS technology in the literature. In the study of Gonzalez et al,⁹ PDL at 595-nm wavelength was used for the cases of KPR and KPAF, a case series with 10 patients. In this research, three cases achieved complete resolution of erythema, other seven cases achieved clearance of erythema over 75%. One patient presented postinflammatory hyperpigmentation for 7 months.

In conclusion, our case with KPAF is the first patient reported to have been treated with 585 nm diode laser with D-WMOPS technology in the literature. Therefore, we think this new technology may be an alternative, safety and efficacy therapeutic option for KPAF treatment. Further large-scale randomized controlled studies are required to determine the optimal protocol of the treatments.