Kuwait City - The management of periorbital syringomas is problematic to say the least, and most inexperienced physicians find it difficult to treat them, even with the current treatment modalities.
Due to the recalcitrant nature of syringomas, other avenues of therapies have been researched, including variations of electrosurgery. One expert in the field talks about his experience with low voltage electrocoagulation and the eye opening successes he has achieved with this relatively unexplored treatment modality.
Syringomas are benign eccrine sweat gland tumors, and though relatively rare, they are the cause of much cosmetic dismay to the affected patient. They typically present as small (1 mm to 3 mm), firm, often clustered, slightly yellowish to flesh colored to translucent dermal papules. They most commonly occur in the periorbital region, but can also occur in other areas, such as the chest and lower abdomen.
Dr. Al Aradi conducted a 20 patient pilot study using low voltage electrocoagulation, at the As'ad Al-Hamad Dermatology Center in Kuwait, evaluating the efficacy of this minimally invasive surgical technique on periorbital syringomas.
In the study, periorbital syringomas were treated with a dual frequency 4MHz radiofrequency device (Surgitron, Ellman International, Inc.) at a power of one or two in electrocoagulation mode.
Patients were followed up every six to eight weeks where treatment effects were observed and further treatment was applied if necessary. All patients were female with a mean age of 27.5 years and had skin types from IV to V.
Study results showed that the electrocoagulation induced significant clinical improvements from the initial visit, with marked clinical improvement seen in 60 percent of the patients - that is, a greater than 70 percent clearance of lesions.
Dr. Al Aradi tellsDermatology Times that excellent results can be achieved with electrocautery when the procedure is performed by experienced physicians. He adds that electrocoagulation has significant benefits over electrodesiccation and electrofulguration, in so far as it has a deeper tissue penetration, causing more destruction and providing longer lasting effects.
In the study, 18 of 20 patients underwent a second treatment, and 17 of 20 had a third treatment. Dr. Al Aradi says that the number of treated lesions varied between 10 and 300 lesions per patient.
"This procedure is simple and very effective. Using the electrocoagulative settings, an electrode is brought into direct contact with a syringoma and moved slowly and carefully across it until charring occurs. Although scarring is always possible, the physician must be very careful to minimize unnecessary tissue or vessel damage," Dr. Al Aradi explains.
In the study, patients did not receive local anesthesia. Dr. Al Aradi explains that this decision helped lessen the risks of periorbital bruising and excessive swelling. The majority of the patients fared well, with only two dropping out due to moderate perioperative pain. Dr. Al Aradi notes that postoperatively, moderate to severe burning, itching and redness, as well as swelling, were seen in half the patients.
He says that the postinflammatory pigmentary changes that occurred (as expected) three to seven days post-treatment improved spontaneously within a few months.
"In my opinion, low voltage electrocoagulation should be considered to be a bonafide treatment option for syringomas. It is a safe, highly effective and inexpensive procedure.
"When used correctly, the adverse effects of this treatment are minimal, self-resolving and nonscarring," Dr. Al Aradi concludes.
Disclosure: Dr. Al Aradi reports no significant interest with commercial supporters.