Effective treatment of Fox–Fordyce disease with pulsed dye laser

Dear Sir, Fox–Fordyce disease (FFD) is a rare inflammatory disorder of apocrine sweat glands, which is clinically characterized by smooth, uniform, firm, folliculocentric, yellow skin-colored papules on apocrine gland-bearing areas (1). Etiology of FFD is still unclear, but epidemiologic data support the role of hormonal component (1, 2). FFD is a treatment-resistant disease, and no certain treatment method has been proven to be curative. Topical and intralesional glucocorticoids, topical and systemic retinoids, topical clindamycin, topical pimecrolimus cream, benzoyl peroxide, oral contraceptives, oral isotretinoin, and ablative lasers have been reported with varying efficacy portion. In recalcictrant cases, mechanical destruction or removal of the apocrine glands can be offered. Pulsed dye laser is a gold standard treatment method for vascular lesions which was first used in the treatment of telangiectatic chronic erythema in 1996 (3). Today, we can use this laser in many different indications both in vascular, inflammatory, and tumoral etiology (4, 5). Effect of this laser has not been reported in the literature before. We want to present a young female patient with Fox–Fordyce disease with good response to pulsed dye laser. A 17-year-old female patient admitted to our outpatient clinic with a 2-year history of no hair growth and no sweating on bilaterally axillar region with excessive itching. Dermatological examination revealed multiple, follicular, skin-colored, 1to 2-mm-diameter papular lesions on bilateral axillary fossa (Fig. 1). Histopathological examination revealed mild dilatation and mild fibrosis in eccrine sweat glands, perifollicular fibrosis and chronic inflammation (Fig. 2). She was diagnosed as FFD with her histological and clinical examinations and topical clobetasol propionate ointment was initiated. In second month of this therapy, no remission was detected and topical pimecrolimus was offered but she could not use this therapy because of irritation. We started pulsed dye laser application (585 nm), 6 weeks apart, with 8 J/cm and after first session both hair growth and sweating were detected, after third session itching was significantly decreased (Figs 3 and 4). We evaluated the clinical response by hair growth clinically and symptomatic decrease of pruritus. The severity of itching was evaluated with visual analog scale which was 10/10 at the beginning and we observe a slow decrease in itching after every session. Her VAS score was 9/10 after first session, 8/10 after second session, 7/10 after third session, 6/10 after fourth session, and 5/10 after fifth session. After sixth session, her itching was 3/10 and almost total remission was detected in pruritus after