Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 329  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CASE REPORT
Year : 2011  |  Volume : 56  |  Issue : 1  |  Page : 77-78
Lymphangioma circumscriptum treated with radiofrequency ablation


Consultant Dermatologist, Carolena Skin, Laser & Research Centre, Jalandhar, Punjab, India

Date of Web Publication10-Mar-2011

Correspondence Address:
Silonie Sachdeva
Carolena Skin Centre, Urban Estate, Phase -1, Jalandhar, Punjab-144022
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.77558

Rights and Permissions

   Abstract 

Lymphangioma circumscriptum (LC), a hamartomatous lymphatic malformation, is a therapeutic challenge for the dermatologist. Various modalities like surgical excision, lasers, and sclerotherapy have been used in the past to treat this notorious skin condition. We report the efficacy of a radiofrequency ablation in a patient with LC. The treatment efficacy of radiofrequency was satisfactory in our patient with no recurrence during 1 year follow-up period. The radiofrequency technique is a safe and economic treatment for management of LC.


Keywords: Lymphangioma circumscriptum, treatment, radiofrequency ablation


How to cite this article:
Sachdeva S. Lymphangioma circumscriptum treated with radiofrequency ablation. Indian J Dermatol 2011;56:77-8

How to cite this URL:
Sachdeva S. Lymphangioma circumscriptum treated with radiofrequency ablation. Indian J Dermatol [serial online] 2011 [cited 2019 Nov 21];56:77-8. Available from: http://www.e-ijd.org/text.asp?2011/56/1/77/77558



   Introduction Top


Lymphangioma circumscriptum (LC) or microcystic lymphatic malformation is a hamartomatous malformation of the lymphatic channels of the skin. Treatment of LC is difficult because of the persistent nature of the disease due to deeper subcutaneous cisternal connections. We report here a case of LC treated effectively with radiofrequency ablation without any recurrence.


   Case Report Top


A 16-year-old male with Fitzpatrick skin type V presented to our clinic with partially fluid-filled lesions on left upper arm with slight local swelling. The patient had these lesions since the age of 2 years and had been repeatedly treated with antibiotics for local infection. Examination showed a well-defined plaque on left upper arm with grouped vesicular lesions, giving the typical appearance of a "frog spawn" and slight localized swelling. There was no other dermatologic or systemic abnormality. There was no family history of similar lesions.

A clinical diagnosis of LC was made. A biopsy was taken from the edge of the lesion and histopathology showed multiple thin-walled, dilated lymphatic spaces in the papillary dermis and these spaces contained lymph and few erythrocytes. The overlying epidermis was thin, and there were elongated rete ridges that appeared to surround the lymphatic channels. The findings were consistent with the clinical diagnosis.

The patient was given a systemic antiobiotic, cefadroxil 500 mg twice daily for 5 days, to treat the infection including oozing from the lesions and to decrease the inflammation. Radiofrequency ablation was done a week later (Basco radiofrequency device, Model RF-B2, high frequency 2 MHz, power <150 W), in cut and coagulate mode with wire loop electrode, under local anesthesia. The wound was dressed using a sterile paraffin pad. The patient was advised to clean the area with betadine lotion and apply topical antibiotic mupirocin on the lesions. Three sessions were required at weekly intervals for the lesions to clear as some deeper components were left untreated at the first two sessions. All the lesions were successfully ablated at third session. One week after last treatment, the area had partially healed with slight depigmentation. At 1 month, the lesions had completely healed and swelling had subsided [Figure 1]. The depigmentation resolved completely at the end of 3 months. There were no side effects of the treatment. Patient was called for monthly follow up. No recurrence has occurred in the past 1 year and the patient is still under surveillance.
Figure 1: (a) LC lesion on the left upper arm; (b) lesions being treated with radiofrequency ablation; (c) immediate post treatment red erythematous area; (d) complete healing of the lesions at 1 month

Click here to view



   Discussion Top


LC is benign ectasia with two components: the clinically obvious, dermal vesicular component, visible on the skin, and the deeper subcutaneous cisternal element. [1] Whimster described the pathogenesis and said that LC arises from the subcutaneous muscle-coated lymphatic cisterns which receive lymphatic flow from the surrounding tissue, but this is not drained to the normal lymphatic system. [2] These dilated cisterns conduct the lymph through communicating channels into the dermal thin lymphatics, which balloon out into the epidermis. Treatment modalities include surgical excision, lasers and sclerotherapy with varying success. [3],[4],[5] We tried the radiofrequency ablation to treat LC, which produced near-complete clinical ablation with coagulation of lesional and perilesional skin leading to fibrosis of the perivesicular lymphatics. Omprakash et al. reported palliative coagulation of LC using radiofrequency current in two cases. They did the follow up for 6 months, which showed no recurrence. [6] They used the coagulation mode only. We, however, used the cut and coagulate mode. The follow up was longer in our case, i.e., 1 year and we are encouraged to do a case series to determine the efficacy of radiofrequency in this notorious condition. This case is being reported to emphasize the importance of radiofrequency treatment in LC. Large-scale studies will have to be carried out to ensure the efficacy.

 
   References Top

1.Mortimer PS. Disorders of lymphatic vessels. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's textbook of dermatology. 6 th ed. Oxford: Blackwell Publishing; 1998. p. 2292.  Back to cited text no. 1
    
2.Whimster I. The pathology of lymphangioma circumscriptum. Br J Dermatol 1976:94:473-86.  Back to cited text no. 2
    
3.Browse NL, Whimster I, Stewart G, Helm CW, Wood JJ. Surgical management of 'lymphangioma circumscriptum'. Br J Surg 1986;73:585-8.  Back to cited text no. 3
[PUBMED]    
4.Molitch HL, Unger ES, Witte CL, van Sonnenberg E. Percutaneous sclerotherapy of lymphangiomas. Radiology 1995;194:343-7.  Back to cited text no. 4
    
5.Lapidoth M, Ackerman L, Amital DB, Raveh E, Kalish E, David M. Treatment of lymphangioma circumscriptum with combined radiofrequency current and 900 nm Diode laser. Dermatol Surg 2006;32:790-94.  Back to cited text no. 5
    
6.Omprakash HM, Rajendran SC. Lymphangioma circumscriptum (microcystic lymphatic malformation): Palliative coagulation using radiofrequency current. J Cutan Aesthet Surg 2008;1:85-8.  Back to cited text no. 6
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1]

This article has been cited by
1 Lymphangioma circumscriptum in the scrotum: a case report
Saroona Haroon,Sheema H Hasan
Journal of Medical Case Reports. 2012; 6(1): 233
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (548 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Case Report
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed3651    
    Printed126    
    Emailed0    
    PDF Downloaded85    
    Comments [Add]    
    Cited by others 1    

Recommend this journal