A Triple Laser Combination Treatment for Facial Angiofibromata Management in Tuberous Sclerosis and Literature Review

Background: Angiofibromas are a common facial manifestation of Tuberous Sclerosis (TS). However, current treatments have proven ineffective due to high recurrence rates and non-compliance. To address this issue, we developed a new triple laser therapy protocol for more effective management of angiofibromas. We conducted tests to validate its efficacy. Methods: This is a prospective study of 10 patients with TS (4 women and 6 men, mean 26.3 years old {15-37 y/o}) with angiofibromata who received triple sequential laser therapy at our private dermatological clinic conducted from January 2000 to December 2022. We evaluated the outcome with the Facial Angiofibromata Severity Index (FASI) via clinical photography (0, 6 months, 1 year, 2 years) and Dermatology Life Quality Index (DLQI). Results: All patients had a successful recovery without any complications. Among these 10 patients, 4 experienced localised recurrences at their 6th-month follow-up. These recurrences were treated with a second single CO2 laser session. After 2 years of follow-up, we observed no recurring facial cutaneous manifestations. Furthermore, all patients experienced a decrease in their FASI score after treatment. According to the Visual Analogue Scale (VAS), patients reported 95% satisfaction, and DLQI indicated only a minor impact on their everyday lives. Conclusion: We believe that this protocol of 3-step Laser treatment is effective, safe, and compliable for patients with facial angiofibromata, providing a satisfactory outcome adaptable to the daily dermatological and plastic surgery practice.