Treatment of Facial Lesions of Multicentric Reticulohistiocytosis by Carbon Dioxide Laser
A 40-year-old female patient, diagnosed with MRH (biopsy proven) 2 years ago, presented at our outpatient department with asymptomatic, nonprogressive, multiple fleshy papules, and nodules over the face [], scalp, retroauricular region [], and nail folds of the finger nails [“coral bead” appearance-]. Xanthelasma palpebrum were visible over both the upper eyelids []. Erythematous nodules were present over both elbows []. She had developed deforming polyarthiritis and shortening of fingers over both hands since 4 years []. Currently, she complained of severe neck pain for which she was to be investigated.\nShe had been on treatment with injectable methotrexate 15 mg once a week since the last 1 year which she discontinued 3 months ago as she was symptomatically better. Currently, she was receiving calcium supplements, folic acid, and pain killers orally. While the joint pain improved, her skin lesions persisted in spite of treatment. The facial lesions were disfiguring causing her psychological distress.\nThe patient was under the combined care of the departments of medicine, orthopedics, and dermatology. She underwent all relevant investigations such as complete blood count (raised Erythrocyte sedimentation rate), liver function tests, renal function tests, antinuclear antibody profile, radiological investigations, including X-ray of affected parts [], Ultra sonography abdomen and computed tomography of the brain; the reports of which were not suggestive of internal malignancy. Skin biopsy [ and ] from a nodule over elbow revealed large mononucleated and multinucleated giant cells with ground glass cytoplasm with a background of fibrosis with scant inflammatory infiltrate in the dermis, thereby reaffirming the diagnosis of MRH.\nWe used CO2 laser to ablate the lesions over the face and retroauricular regions. In the first sitting, the nasolabial lesions were targeted. Topical anesthesia (combination cream of tetracaine and lidocaine) was applied an hour prior to procedure. CO2 laser at 7.0 W with a 100 mm hand piece (1.0 mm spot size) in superpulse mode was used to ablate the lesions. There was no significant bleeding during or postprocedure. Topical antibiotic cream (fusidic acid 1%) was applied after the procedure. A follow-up after 3 weeks revealed that the skin had healed with no significant hyperpigmentation or scarring [].\nThe other involved sites were treated similarly and follow-up was done after another 3 weeks []. The results were excellent both subjectively and objectively. Currently, the patient has been on steady follow-up for 8 months with no recurrence of lesions over the ablated sites.