Treatment of dermatofibroma with a 600 nm pulsed dye laser

BACKGROUND: Dermatofibroma (DF) is one of the most basic and common dermatologic diseases treated by practicing dermatologists on a daily basis. Although benign, it can be pruritic or tender. Furthermore, it is difficult to treat effectively with optimal cosmetic outcomes. OBJECTIVE: We report a safe, effective, and cosmetically superior method of treating DF with the 600 nm pulsed dye laser (PDL). METHODS: We used a 600 nm PDL to treat 20 lesions from 18 Caucasian patients. The laser parameter was set at a fluence of 7 J/cm², a spot size of 7 mm and a pulse duration of 1.5 ms. Each lesion was treated three times at a 6- to 8-week interval. For each treatment, the lesion was double pulsed with a 20 to 30% overlap. Clinical improvement was graded by a single examiner in evaluating three clinical parameters: color, size/volume, and symptoms. For each parameter, improvement was ranked as no improvement, partial improvement, and complete response. RESULTS: All 18 patients (17 women) completed the study. For the volume/size parameter, 15 of 20 lesions (75%) showed complete response. For improvement in color, 12 of 20 patients (60%) showed complete response. Only six lesions were symptomatic (i.e., tender and irritating), and all six lesions showed complete resolution of symptoms after the PDL treatments. After each treatment, all patients experienced blistering, crusting, and purpura that usually resolved after 10 days. CONCLUSIONS: We have demonstrated for the first time that PDL (600 nm and 1.5 ms pulse duration) is an effective and safe treatment of DF. It may provide superior cosmetic outcomes compared with other modalities such as surgical excision.