Surgical removal of a small number of BHD skin lesions has been reported to work in some cases. However, there can be scarring and there is no guarantee that this solution is permanent.
Curettage uses a curette (a sharp spoon-shaped surgical implement) to remove skin lesions. It is most commonly combined with other treatments such as cautery.
Cautery uses a heated electrode to destroy skin tissue. This technique can also destroy normal tissue near to the skin lesions being treated and can cause scarring.
Cold cautery, or cryosurgery, is like cautery but uses extreme cold to freeze the lesion instead. This treatment has minimal pain and scarring; however, there is a risk of nerve damage to surrounding healthy tissue.
Electrocautery, fulguration, electrodessication, electrosection and hyfrecation are all types of radiofrequency ablation. Radiofrequency treatments use a probe to deliver an electric current directly to target tissues, which rapidly heats and destroys them.
An electrode is used to treat the surface of the skin, and is often used for skin resurfacing or tightening in cosmetic procedures. Radiofrequency ablation causes fewer side effects than cautery.
Hyfrecation has been reported to successfully treat a BHD patient’s fibrofolliculmas with no recurrence 2 years after treatment. Combined curettage and hyfrecation has been reported to treat a BHD patients’ fibrofolliculomas with minimal recurrence 3 years after treatment (1,2).
Cryoablation is a freezing technique similar to cold cautery where cold electrodes are used to freeze and destroy tissue. The treatment is very precise and leaves less scarring than traditional surgery. The cold deadens tiny nerve endings so there may be less pain as well.
Both radiofrequency ablation and cryoablation have also been used successfully to treat kidney tumours (see kidney treatment).
There are several types of laser treatments that have been used to treat BHD patients’ skin lesions with some success, but the most commonly used are CO2 lasers, Erbium:YAG lasers, or a combination of the two.
Laser treatments can give good results initially, with little scarring, but long-term results seem to vary between patients. One study reports new skin lesion growth 6 months after treatment, whilst another study reports no new skin lesion growth four years after treatment (3,4)
1. Pritchard S, Mahmoudizad R, Parekh P. Successful treatment of facial papules with electrodessication in a patient with Birt-Hogg-Dubé syndrome. undefined. 2014;
2. Farrant PBJ, Emerson R. Letter: Hyfrecation and curettage as a treatment for fibrofolliculomas in Birt-Hogg-Dube syndrome  [Internet]. Vol. 33, Dermatologic Surgery. Dermatol Surg; 2007 [cited 2021 May 18]. p. 1287–8. Available from: https://pubmed.ncbi.nlm.nih.gov/17903168/
3. Gambichler T, Wolter M, Altmeyer P, Hoffman K. Treatment of Birt-Hogg-Dube syndrome with erbium:YAG laser. J Am Acad Dermatol. 2000 Nov 1;43(5):856–8.
4. Truchuelo MT, Alcántara J, Allende I, Almazán-Fernández FM, Boixeda P, González C. Multiple facial papules of Birt-Hogg-Dubé syndrome treated with a CO2 laser [Internet]. Vol. 23, Annals of Dermatology. Korean Dermatological Association; 2011 [cited 2021 May 20]. p. S279-80. Available from: http://dx.doi.org/10.5021/ad.2011.23.S2.S279
Publication date: December 2014
Review date: May 2021