LASER TREATMENT OF BENIGN CUTANEOUS VASCULAR LESIONS

  • Uroš Ahčan Klinični oddelek za plastično kirurgijo in opekline Kirurška klinika Klinični center Zaloška 7 1525 Ljubljana
  • Peter Zorman Klinični oddelek za plastično kirurgijo in opekline Kirurška klinika Klinični center Zaloška 7 1525 Ljubljana
  • Simon Ralca Klinični oddelek za plastično kirurgijo in opekline Kirurška klinika Klinični center Zaloška 7 1525 Ljubljana
  • Dejan Recek Klinični oddelek za plastično kirurgijo in opekline Kirurška klinika Klinični center Zaloška 7 1525 Ljubljana
  • Boris Majaron Klinični oddelek za plastično kirurgijo in opekline Kirurška klinika Klinični center Zaloška 7 1525 Ljubljana
Keywords: selective photothermolysis, long-pulse laser, KTP, Nd, YAG

Abstract

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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References

Mulliken JB, Glowacki J. Classification of pediatric vascular lesions. Plast Reconstr Surg 1982; 70: 120–1.

Achauer BM, Vander Kam VM. Vascular lesions. Clin Plast Surg 1993; 20: 43–51.

Dixon JA, Huether S, Rotering R. Hypertrophic scarring in argon laser treatment of port-wine stains. Plast Reconstr Surg 1984; 73: 771–9.

Anderson RR, Parrish JA. Selective photothermolysis: Precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220: 524–7.

Nelson JS, Majaron B, Kelly KM. Active skin cooling in conjunction with laser dermatologic surgery. Semin Cutan Med Surg 2000; 19: 253–66.

Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988; 124: 869–71.

Parrish JA, Anderson RR, Harrist T, Paul B, Murphy GF. Selective thermal effects with pulsed irradiation from lasers: from organ to organelle. J Invest Dermatol 1983; 80: Suppl: 75s–80s.

Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics 1976; 58: 218–22.

Barsky SH, Rosen S, Geer D et al. The nature and evolution of port-wine stains: A computer-assisted study. J Invest Dermatol 1980; 74: 154–7.

Alster TS, Tan OT. Laser treatment of benign cutaneous vascular lesions. Am Fam Physician 1991; 44: 547–54.

Landthaler M, Haina D, Brunner R et al. Neodymium: YAG laser therapy for vascular lesions. J Am Acad Dermatol 1986; 14: 107–17.

Tan OT, Carney JM, Margolis R et al. Histologic responses of port-wine stains treated by argon, carbon dioxide, and tunable dye lasers: A preliminary report. Arch Dermatol 1986; 122: 1016–22.

Alster TS, Wilson F. Treatment of port-wine stains with the flashlamp-pumped pulsed dye laser: Extended clinical experience in children and adults. Ann Plast Surg 1994; 32: 478–84.

Ashinoff R, Geronemus RG. Flashlamp-pumped pulsed dye laser for portwine stains in infancy: Earlier versus later treatment. J Am Acad Dermatol 1991; 24: 467–72.

Garden JM, Polla LL, Tan OT. The treatment of port-wine stains by the pulsed dye laser. Arch Dermatol 1988; 124: 889–96.

Goldman MP, Fitzpatrick RE, Ruiz-Esparza J. Treatment of port-wine stains (capillary malformation) with the flashlamp-pumped pulsed dye laser. J Pediatr 1993; 122: 71–7.

Reyes BA, Geronemus RG. Treatment of port-wine stains during childhood with the flashlamp-pumped pulsed dye laser. J Am Acad Dermatol 1990; 23: 1142–8.

Tappero JW, Grekin RC, Zanelli GA et al. Pulsed dye laser therapy for cutaneous Kaposi’s sarcoma associated with acquired immunodeficiency syndrome. J Am Acad Dermatol 1992; 27: 526–30.

Alster TS. Laser treatment of vascular lesions. In: Alster TS ed. Manual of cutaneous laser techniques. Philadelphia: Lippincott-Williams & Wilkins, 2000: 33–52.

Ho WS, Chan HH, Ying SY, Chan PC. Laser treatment of congenital facial port-wine stains: long-term efficacy and complication in Chinese patients. Lasers Surg Med 2002; 30: 44–7.

Lorenz S, Scherer K, Wimmershoff MB, Landthaler M, Hohenleutner U. Variable pulse frequency-doubled Nd:YAG laser versus Flashlamp-pumped pulsed dye laser in the treatment of port wine stains. Acta Derm Venerol 2003; 83: 210–3.

Travelute-Ammirati C, Carniol PJ, Hruza GJ. Laser treatment of facial vascular lesions. Facial Plast Surg 2001; 17: 193–201.

Waner M, Suen JY. The natural history of vascular malformations. In: Waner M, Suen Y eds. Hemangiomas and vascular malformations of the head and neck. New York: Wiley-Liss, 1999: 47–82.

Rothfleisch JE, Kosann MK, Levine VJ, Ashinoff R. Laser treatment of congenital and acquired vascular lesions. A review. Dermatol Clin 2002; 20: 1–18.

Blickenstaff RD, Roenigk RK, Peters MS et al. Recurrent pyogenic granuloma with satellitosis. J Am Acad Dermatol 1989; 211: 1241–4.

Goldman MP, Fitzpatrick RE. Treatment of cutaneous vascular lesions. In: Goldman MP, Fitzpatrick RE eds. Cutaneous laser surgery: The art and science of selective photothermolysis. St. Louis: Mosby-Year Book, 1994: 19–105.

Tay YK, Weston WL, Morelli JG. Treatment of pyogenic granuloma in children with the flashlamp-pumped pulsed dye laser. Pediatrics 1997; 99: 368– 70.

Landthaler M, Haina D, Waidelich W et al. Laser therapy of venous lakes (Bean-Walsh) and telangiectasias. Plast Reconstr Surg 1984; 73: 78–81.

Bailin PL. Use of the CO2 laser for non-PWS cutaneous lesions. In: Arndt KA, Noe JM, Rosen S eds. Cutaneous laser therapy: Principles and methods. Chichester: Wiley, 1983: 192–3.

Fitzpatrick RE, Goldman MP. CO2 laser surgery. In: Goldman MP, Fitzpatrick RE eds. Cutaneous laser surgery: The art and science of selective photothermolysis. St. Louis: Mosby-Year Book, 1994: 219–9.

Ross M, Watcher MA, Goodman MM. Comparison of the flashlamp pulsed dye laser with the argon tunable dye laser with robotized handpiece for facial telangiectasia. Lasers Surg Med 1993; 13: 374–8.

Goldman MP, Bennet RG. Treatment of telangiectasia: A review. J Am Acad Dermatol 1987; 17: 167–82.

Goldman MP, Weiss RA, Brody HJ et al. Treatment of facial telangiectasia with sclerotherapy, laser surgery, and/or electrodesiccation: A review. J Derm Surg Oncol 1993; 19: 899–906.

Gonzalez E, Gange RW, Momtaz KT. Treatment of telangiectasias and other benign vascular lesions with the 577 nm pulsed dye laser. J Am Acad Dermatol 1992; 27: 220–6.

Ruiz-Esparza J, Goldman MP, Fitzpatrick RE et al. Flashlamp-pumped dye laser treatment of telangiectasia. J Derm Surg Oncol 1993; 19: 1000–3.

Friedman PM, Mafong EA, Friedman ES, Geronemus RG. Topical anesthetics update: EMLA and beyond. Dermatol Surg 2001; 27: 1019–26.

Moraga JM, Polla L, Hoffman S, Troxler M, Levy JL. European multi-central study: PhotoDerm VascuLight for the treatment of varicose reticular veins and leg telangiectasias, as well other vascular lesions. ESC Medical Systems Ltd. Clinical Application Notes 1999; 8: (1).

Alora MB, Dover JS, Arndt KA. Lasers for vascular lesions. Dermatol Nurs 1999; 11(2): 97–102.

How to Cite
1.
Ahčan U, Zorman P, Ralca S, Recek D, Majaron B. LASER TREATMENT OF BENIGN CUTANEOUS VASCULAR LESIONS. ZdravVestn [Internet]. 1 [cited 18Apr.2019];73(7-8). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2342
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Professional Article