Journal of Cosmetics, Dermatological Sciences and Applications, 2012, 2, 130-131
http://dx.doi.org/10.4236/jcdsa.2012.23025 Published Online September 2012 (http://www.SciRP.org/journal/jcdsa)
Atrophoderma Vermiculata Successfully Treated by
595 nm Dye Laser and Carbon Dioxide Laser
Hidetoshi Takahashi*, Yoshio Hashimoto, Masuru Honma, Akemi Ishida-Yamamoto, Hajime Iizuka
Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan.
Received April 23rd, 2012; revised May 26th, 2012; accepted June 10th, 2012
ABSTRACT
The treatment of atrophoderma vermiculatum is challenging. A 7-year-old girl had a unilateral atrophic skin lesion on
her right cheek, which was diagnosed as unilateral atrophoderma vermiculata. She was treated by carbon dioxide and
595 nm pulsed dye laser and carbon dioxide laser. This resulted in prevention of the lesional progression with favorable
cosmetic appearance of the skin.
Keywords: Atrophoderma Vermiculata; Dyed Laser; Carbon Dioxide Laser
1. Introduction
A 7-year-old Japanese girl had a 2-year history of atro-
phic skin lesion on her right cheek. She had been treated
by a local dermatologist with topical corticosteroid with-
out response. Examination showed grouped atrophic
scars in a honeycomb pattern accompanied with slight
erythema on her right cheek (Figure 1(a)). The patient
had not suffered from any preceding skin lesion and
was in good health. No family history was detected.
Physical examination and laboratory investigations in-
cluding blood analyses, liver and renal functions and
urinalysis, were all within normal limits. The patient re-
fused a biopsy.
We performed pulsed dye laser irradiation (V-Beam;
Candela Corp, Wayland, MA, USA) at 595 nm with 1.5-
msec pulse-duration and at an energy fluence of 12 J/cm2
using the 7 mm spot diameter. Although slight skin
swelling was observed following the irradiation, edema
was improved within 48 hr. After 3 months, we per-
formed face resurfacing using a high-energy, pulsed car-
bon dioxide laser (NIDEK CO., LTD) at 300 mJ energy
and 60 W power through 10 mm2 scanning hand piece
and 30% density. The laser-irradiated skin showed pale
pink erosion without bleeding and gentamycin ointment
was applied until reepithelization was completed (7 days).
Significant lesional improvement was observed after 6
months following the laser irradiation (Figure 1(b)).
2. Discussion
Atrophoderma vermiculatum is a rare, benign inflamma-
tory follicular atrophy that mainly affects cheeks of chil-
dren. Clinical morphological hallmark is “worm-eaten”
or “honey-combed” reticular atrophy. The pathogenesis
is speculated as an abnormal keratinozatation of pilose-
baceous units [1]. Atrophoderma vermiculatum usually
affects both cheeks and only 3 cases of unilateral atro-
phoderma vermiculatum have been reported [2-4]. Hsu et
al. [2] reported a case associated with ipsilaretal cataract,
alopecia, and a seizure. This suggests that some type of
atrophoderma vermiculatum should be regarded as a
neurocutaneous syndrome such as seen in epidermal ne-
vus and nevus comedonicus.
The treatment of atrophoderma vermiculatun is chal-
lenging. Previous reports showed the effectiveness of
systemic isotretinoin or topical tretionin [5-7]. Although
isotretinoin is useful for atrophoderma vermiculatum,
adverse effects such as hyperlipidemia, cheilitis, and
premature epiphyseal closure limit its use. In contrast,
(a) (b)
Figure 1. Clinical appearance of skin lesion before and after
the laser irradiation. (a) Patients before the treatment: Group-
ed, honeycomb-patterned atrophic scar with erythema; (b)
Improvement of the skin lesion following after the 595 nm
dye laser and carbon dioxide laser.
*Corresponding author.

Atrophoderma Vermiculata Successfully Treated by 595 nm Dye Laser and Carbon Dioxide Laser 131
local laser treatment is less harmful and could be the
first-choice treatment for the atrophoderma vermicula-
tum.
The usefulness of dye laser for inflammation such as
psoriasis and scarred condition has been described [8-10].
Recently, pulsed dye laser and carbon dioxide laser have
been successfully applied [11,12]. Previous reports showed
that 585 nm dye laser, which is vascular-specific modal-
ity, was effective for atrophoderma vermiculatum. In our
case, 595 nm dye laser was also effective for inflamma-
tory atrophoderma vermiculatum. Dye laser with 595 nm
is more penetrant and more potent than 585 nm dye laser
and it was successfully applied for the atrophoderma
vermiculatum. Furthermore, carbon dioxide laser was
effective for the atrophic scar and our case confirmed its
effect for the atrophoderma vermiculatum [12]. The me-
chanism is derived from both removal of fibrotic tissue
and regeneration of collagen synthesis after its shrinkage
[4]. Therefore, we speculate that the treatment using both
dye laser and carbon dioxide laser is more useful than the
treatment of either modality.
In conclusion, 595 nm pulsed dye laser and carbon di-
oxide laser were applied for a case of unilateral atropho-
derma vermiculatum with favorable cosmetic response
without adverse events.
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