Successful Treatment of Upper Limb Superficial Lymphatic Malformation With Topical Sirolimus.

Lymphatic malformation (LM) is a congenital anomaly of the lymphatic system that can affect various anatomical sites, most commonly skin and subcutaneous tissues. Treatments that were historically used, including surgery, laser therapy (pulsed dye laser [PDL] and CO2 laser), and sclerotherapy, can be associated with complications such as bleeding and lesion recurrence. Oral sirolimus is effective in treating LMs but can be associated with systemic side effects, including immunosuppression and metabolic disturbances. Targeting the mTOR pathway, topical sirolimus effectively treats superficial LMs with minimal adverse effects compared to systemic administration. Several studies have reported that topical sirolimus shows comparable outcomes with minimal side effects. We present the case of a 19-year-old woman with bleeding from a superficial LM on the lateral aspect of her upper limb. Previous treatments, including carbon dioxide laser therapy and PDL, were ineffective. Within 3 months after initiating 0.1% topical sirolimus application twice daily, a noticeable reduction in lesion size and bleeding was observed, with no adverse effect.