10.5826/dpc.1401a4
text/xml
2160-9381
3209
en
Trovato Emanuele
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
laser
Combination of Fractional CO2 Laser Therapy and Photodynamic Therapy for the Treatment of Plasma Cell Cheilitis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2024-01-31
2023-02-02
2024-01-31
2024-02-21
e2024004
Dermatol Pract Concept
Trovato Emanuele
2024/01/31
10.5826/dpc.1401a4
e2024004
Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, Siena, Italy
2160-9381
laser
en
e2024004
Cortonesi G, Donelli C, Orsini C, Guidi I, Rubegni P, Trovato E. Combination of CO2 laser therapy and pulsed dye laser therapy for the treatment of actinic cheilitis. [published online ahead of print, 2022 Nov 16]. J Cosmet Dermatol. 2022;10.1111/jocd.15494.
Combination of Fractional CO2 Laser Therapy and Photodynamic Therapy for the Treatment of Plasma Cell Cheilitis
https://dpcj.org/index.php/dpc/article/download/3209/2540
         Combination of Fractional CO2 Laser Therapy
         and Photodynamic Therapy for the Treatment
                   of Plasma Cell Cheilitis
 Giulio Cortonesi1, Carolina Donelli1, Corinne Orsini1, Pietro Rubegni1, Emanuele Trovato1


1 Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, Siena, Italy



Key words: plasma-cell, cheilitis, laser
Citation: Cortonesi G, Donelli C, Rubegni P, Trovato E. Combination of Fractional CO2 Laser Therapy and Photodynamic Therapy for the
Treatment of Plasma Cell Cheilitis. Dermatol Pract Concept. 2024;14(1):e2024004. DOI: https://doi.org/10.5826/dpc.1401a4
Accepted: July 6, 2023; Published: January 2024
Copyright: ©2024 Cortonesi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Carolina Donelli, MD, Dermatology Section, Santa Maria Alle Scotte Hospital, Viale Bracci 16, 53100 Siena, Italy.
E-mail: carolina.donelli@gmail.com




Introduction                                                             lip (Figure 1, A and B), persistent for eighteen months and
                                                                         already histologically diagnosed as plasma cell cheilitis. Since
Plasma cell cheilitis (PCC) is a rare idiopathic inflamma-               the diagnosis high-potency topical corticosteroid and tacroli-
tory disorder of the oral mucosa characterized by a dense                mus 0.03% ointment had been utilized for six months, with
band-like infiltrate of plasma cells in the upper dermis [1,2].          no clinical benefit. We decided to try a combined treatment
The most common clinical presentation is a slowly evolv-                 with fractional CO2 laser therapy and photodynamic therapy
ing, ­erythematous-violaceous, ulcerated, and asymptomatic               (PDT). First, under topical anesthesia, the patient underwent
plaque of the lower lip. A biopsy with histological examina-             a fractional CO2 laser (Smartxide2, DEKA MELA) ablative
tion is generally required to make a differential diagnosis.             treatment (power 5 W, scan time 300 ms, spacing 400 µm)
PCC is not used to resolve spontaneously and it is often re-             and, immediately afterward, methyl aminolevulinate (MAL)
sistant to topical steroid treatment. The resolution has been            160 mg/g cream was applied on the treated area using an
documented after systemic or intralesional steroids, systemic            occlusive and nontransparent plastic wrap. Three hours later,
griseofulvin, topical calcineurin inhibitors, and destructive            the occlusive dressing was removed and the treated skin was
measures, including laser therapy [2,3]. Successful therapeu-            exposed to 120 J/cm2 of a red-light source with peak emis-
tic results have been achieved by combining two different                sion at 630 nm (PDT-CLD 100, EPEM) for two minutes. Af-
therapies that act synergistically [4].                                  ter therapy, the patient was warned to avoid direct sunlight
                                                                         for the first 36 hours. To promote quick healing, she was

Case Presentation                                                        advised to apply until complete re-epithelialization a topical
                                                                         non-medicated ointment. Other two cycles of fractional CO2
We report the case of a 40-year-old woman, who presented to              laser therapy and subsequent PDT were done, after 4 and 8
our dermatology clinic with an ulcerated plaque of the lower             (Figure 1, C and D) weeks. A follow-up was performed



Research Letter | Dermatol Pract Concept. 2024;14(1):e2024004                                                                          1
                   Figure 1. Clinical (A,C,E) and dermoscopic (B,D,F) presentation of the lesion before treatment
                   (A,B), after 8 weeks (C,D) and at 12 months follow-up (E,F).



12 months after the first treatment. The patient reported only      with wider samples of patients are needed to validate this
mild discomfort related to the red-light exposure after the first   technique as a therapeutic standard for PCC.
treatment cycle, then well controlled by the preventive use of
sunscreens. The aesthetic outcome was excellent, without any
                                                                    References
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cell death by necrosis and apoptosis. PDT is able to selec-             subsequent tacrolimus 0.03% ointment in refractory plasma cell
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                                                                     5. Cortonesi G, Donelli C, Orsini C, Guidi I, Rubegni P, Trovato E.
because of proven efficacy, minimum associate discomfort,
                                                                        Combination of CO2 laser therapy and pulsed dye laser ther-
and good aesthetic outcome. Moreover, besides the fact that             apy for the treatment of actinic cheilitis. J Cosmet Derma-
they are all off-label, the distress associated with using top-         tol. 2023;22(2):715-716. DOI: 10.1111/jocd.15494. PMID:
ical treatments for long periods is greater. Further studies            36382418.




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