Efficacy of the combination of minimally invasive CO2 laser incision with photodynamic therapy for infected epidermoid cysts.

Abstract

There are three main techniques for the removal of epidermoid cysts: traditional wide excision, minimal excision, and punch biopsy excision. For inflamed cysts, the wall is more friable and, therefore, more difficult to remove completely. The classic surgical excision always leads to a long scar or high rate of recurrence. CO2 laser has been proven to result in minimal incision, less bleeding, no suture, and a smaller or no scar. Photodynamic therapy (PDT) has been proposed as an antimicrobial alternative for common and drug-resistant bacteria in nonspecific and multiple sites. It was also shown to be effective in accelerating healing and inhibiting excessive proliferation of hyperplastic scar. Thus, we combined minimally invasive CO2 laser incision with PDT for epidermoid cysts with infection. Thirty-three patients had a total of 39 infectious cysts. Two of the patients withdrew due to the high cost after 1 treatment session. After local injection of anesthesia, a hole measuring 2-3 mm was made at the pore in the upper part of the cyst along skin texture by CO2 laser (power 5 W, surgical pattern). The contents of the cyst were extracted through the hole using a curette and compression with gauze. PDT was then performed immediately. A total of 3 PDT sessions were recommended. The overall clinical effects, recurrence rates, cosmetic outcomes, adverse events, and patient satisfaction were assessed. We achieved a 97% success rate in 31 patients with 34 lesions using a combination of minimally invasive CO2 laser incision with PDT. At the 6- to 12-month follow-up, 30 of the patients had excellent cosmetic outcomes and satisfactory therapeutic effect. Pain during the illumination process, which can be relieved by dynamic cold air, was the primary adverse event. Our results demonstrate promise for the combination of minimally invasive CO2 laser incision with PDT as a safe and effective therapy for epidermoid cysts with infection. This treatment can inactivate a wide range of microbes including gram-positive and -negative bacteria, without developing drug resistance. Furthermore, it can promote fast wound healing and reduce scar formation.