Dermatofibromas are common, benign skin growths, typically appearing as firm, small nodules on the lower legs or arms. They usually measure between 0.5 to 1.5 centimeters and vary in color from pink to light brown or dark brown to black. Although generally harmless, individuals may seek treatment for various reasons.
Why Treat a Dermatofibroma?
Individuals often consider treatment for dermatofibromas for several reasons. Cosmetic appearance is a common motivation, particularly if the growth is in a visible area or causes self-consciousness. The lesion’s raised nature can also lead to physical discomfort, such as itching, tenderness, or pain, especially if irritated by clothing or shaving.
Another reason for removal can be diagnostic uncertainty. Dermatofibromas can sometimes resemble other skin lesions. In such cases, removal allows for pathological examination of the tissue to confirm the diagnosis and rule out other conditions. Treatment is often an elective choice, driven by personal comfort or aesthetic preferences.
Non-Surgical Treatment Methods
For asymptomatic dermatofibromas, simply observing the lesion over time is a valid approach, as many remain stable in size and do not require intervention. If treatment is desired, several less invasive options are available.
Cryotherapy
Cryotherapy involves applying liquid nitrogen to freeze the dermatofibroma tissue. This method can reduce the size of the lesion, but it may not completely remove it and carries a higher chance of recurrence. Potential side effects include temporary blistering, swelling, itching, and changes in skin pigmentation. Initial healing typically occurs within 7 to 14 days.
Laser Therapy
Laser therapy can be used to flatten or improve the cosmetic appearance of dermatofibromas. Pulsed dye lasers (PDL) target the blood vessels within the lesion, while carbon dioxide (CO2) lasers can ablate the tissue. While effective for some, laser treatment may require multiple sessions and can lead to side effects such as post-inflammatory hyperpigmentation, temporary pain, or slight scarring.
Intralesional Injections
Intralesional injections involve delivering corticosteroids, such as triamcinolone, directly into the dermatofibroma. These injections aim to flatten the lesion and reduce its size, particularly for those that are symptomatic or inflamed. The results of intralesional steroid injections can be variable, and they may need to be repeated every 4 to 8 weeks.
Surgical Treatment Methods
When definitive removal is desired, surgical options are considered.
Surgical Excision
Surgical excision involves the complete removal of the dermatofibroma using a scalpel. This procedure typically includes a small margin of surrounding healthy tissue to ensure the entire lesion is removed, which results in the lowest chance of recurrence. The removed tissue can then be sent for pathological examination. Surgical excision usually results in a linear scar, and the procedure is performed under local anesthesia.
Shave Excision
Shave excision is a less invasive surgical technique where the dermatofibroma is shaved off at or just below the skin surface. This method is often chosen for cosmetic reasons as it tends to result in a flatter, less noticeable scar. However, because the deeper parts of the lesion may remain, shave excision has a higher chance of recurrence. It is generally best suited for more superficial dermatofibromas.
Post-Treatment Expectations
After treatment, initial healing typically takes 7 to 14 days, during which the wound should be kept clean and protected. Patients may experience temporary redness, swelling, soreness, or bruising. Full skin remodeling and scar maturation can take several months.
Scarring
Some degree of scarring is inevitable. Its appearance can be influenced by the treatment method, lesion’s location, and individual healing characteristics. Proper aftercare, including using silicone sheets or topical scar treatments and consistent sun protection, can help improve the cosmetic outcome of the scar.
Recurrence
Recurrence exists, particularly with less invasive methods like cryotherapy or shave excision. While complete surgical excision offers the lowest recurrence rates, new dermatofibromas can develop in other areas. If a dermatofibroma reappears or exhibits any unusual changes in size, color, or texture after treatment, further evaluation by a healthcare provider is recommended.