18]. Twenty-seven percent of subjects in the treatment

arms reported that “the treatment made no difference”, versus 62% of subjects in the placebo arm. No subject reported that they “got worse on check details the treatment”. There was no statistically significant difference in the response between subjects on high-dose and low-dose treatment. Fig 1 Study subject (a) prior to therapy and (b) following 6 months of treatment with topical rapamycin. The subject reported complete resolution of his Forskolin molecular weight facial angiofibromas. Serious Adverse Events Among the study subjects, a serious single adverse event occurred in a patient in the low-dose arm of the study. This subject aspirated during a seizure and developed pneumonia, which progressed to septic shock. His rapamycin concentrations were undetectable at the time of hospital admission, and he was immediately withdrawn from the study. His illness required see more prolonged hospitalization, but he has since made a full recovery. Discussion and Conclusion TSC is a genetic disorder affecting 1 in 6000 individuals worldwide. It is characterized by abnormal skin

pigmentation and tumor formation in multiple organ systems. Facial angiofibromas are benign skin tumors found on the faces of patients with TSC, and the angiofibromatous lesions appear as red or pink papules distributed over the central face, most notably on the nasolabial folds, cheeks, and chin. Lesions appear in early childhood and are present in up to 80% of TSC patients, creating considerable cosmetic

morbidity. Since the initial descriptions of facial angiofibromas in the 19th century, multiple treatments have been developed, attempting to alleviate the appearance of these lesions, including curettage, cryosurgery, chemical peels, dermabrasion, shave excisions, and laser therapy. Progesterone Although the majority of these treatments are initially effective, they are uncomfortable, and over time the lesions recur. Recent case reports and small case series have demonstrated that a topical rapamycin formulation might be efficacious,[18–27] but prior reports have consisted of small series without placebo arms. The primary goal of this study was to determine whether our topical formulation of rapamycin was safe for topical use in the treatment of facial angiofibromas in patients with TSC. The study was designed to see if application of the investigational product resulted in detectable systemic absorption of the rapamycin. The secondary goal of this study was to evaluate whether the topical product decreased the appearance of the facial angiofibromas after 6 months of usage, as self-reported by the subjects. Twenty-three study subjects applied either a placebo or the investigational product nightly to their lesions for 6 months.