LASER TREATMENT OF BENIGN CUTANEOUS VASCULAR LESIONS
Background. Congenital and acquired vascular lesions of the skin and subcutis are a common health problem from aesthetic and also from psycho-social point of view. However, recent advances in laser technology have enabled an efficient and safe treatment. This study presents our experience with treatment of cutaneous vascular lesions using modern laser systems. Most common benign cutaneous vascular lesions are described.
Patients and methods. In years 2002 and 2003, 109 patients, 4 to 80 (mean 39) years old, Fitzpatrick skin type 1–4, with 210 benign cutaneous vascular lesions were treated using the Dualis VP® laser system (Fotona, Slovenia) which incorporates the KTP and Nd:YAG lasers. Vascular lesions in the upper layers of the skin with diameter up to 1 mm were treated with the KTP laser (wavelength 532 nm). For larger vessels in deeper layer we used the Nd:YAG laser (wavelength 1064 nm). Patients graded the pain during treatment on a scale of 1–10. Clinical outcomes were evaluated 1–3 months after the last treatment: according to the percentage of clearance of the lesion compared to the adjacent normal skin and for the presence of adverse effects. According to these criteria each lesion was assigned a score: poor (0–25%), fair (26–50%), good (51–75%), excellent (76–100%).
Results. Immediate response after application of a laser beam with proper characteristics was whitish-grey discoloration of treated area. Treatment results after 1–3 months were excellent in 48.1%, good 40.9%, fair in 8.6% and poor in 2.4%. Patients without prior anaesthesia graded pain during treatment from 1 to 8 (mean 4.0) and patients with EMLA® anaesthesia from 1 to 6 (mean 2.6). Side effects were frequent but minimal and transient. Erythema disappeared in several days after treatment while crusting persisted for 14 days. 3 permanent hyperpigmentations, 2 permanent hypopigmentations, 2 hypertrophic scars and 1 beam sized atrophic scar were detected at last follow-up visit.
Conclusions. In addition to clinical experience and correct diagnosis of the lesion, at least two lasers with different wavelengths are necessary for safe and efficient treatment of various cutaneous vascular lesions.The combination of the KTP (532 nm) and Nd: YAG (1064 nm) lasers incorporated in the Dualis VP® system offers great possibilities for treatment of various vascular anomalies on face, lower limbs, as well as other regions.
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