Capillary Malformations Treated With Sequential Pulsed Dye and Nd:YAG Laser Therapy: A Retrospective Study. / Malformaciones capilares tratadas con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo.

INTRODUCTION AND OBJECTIVE: Capillary malformations are the most common vascular malformations in childhood. The current treatment of choice is pulsed dye laser (PDL) therapy, but this frequently does not result in complete resolution. The search for alternative treatment strategies thus continues. In this study we describe our experience with the use of sequential dual-wavelength PDL and Nd:YAG laser therapy in patients with capillary malformations. MATERIAL AND METHODS: We conducted a retrospective, descriptive study of patients with capillary malformations treated with dual-wavelength PDL and Nd:YAG laser therapy between 2006 and 2011. Four dermatologists rated the effectiveness of treatment on a scale of 10 to 0. We also investigated the potential value of the following factors as predictors of better treatment response: sex, malformation size and color, and presence of associated hypertrophy. Adverse effects were also analyzed. RESULTS: We studied 71 patients and most of them experienced a statistically significant improvement after treatment. More favorable responses were observed for violaceous malformations, lesions with associated hypertrophy, and smaller lesions. Adverse effects were reported for 26.76% of patients, and the most common effect was the appearance of isolated areas of skin atrophy. CONCLUSIONS: We consider that sequential dual-wavelength PDL and ND:YAG laser therapy is an effective alternative for treating capillary malformations in selected patients.

Hemangiomas infantiles tratados con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo / Infantile Hemangiomas Treated by Sequential Application of Pulsed Dye Laser and Nd:YAG Laser Radiation: A Retrospective Study

Introducción: Los hemangiomas infantiles son los tumores benignos más frecuentes en la infancia, presentando una fase proliferativa, una fase de involución y una fase residual. En muchas ocasiones no precisan de un tratamiento activo. No obstante, en algunos pacientes se impone la necesidad de un tratamiento. Entre las posibilidades terapéuticas ha demostrado utilidad, durante todas las fases evolutivas de la lesión, el tratamiento con láser. Comunicamos nuestra experiencia con el láser dual secuencial de colorante pulsado (LCP) y Nd:YAG. Material y métodos: Se efectuó un estudio retrospectivo y descriptivo de los pacientes con hemangiomas infantiles en diversas fases evolutivas tratados con el láser dual de LCP y Nd:YAG. Cuatro dermatólogos valoraron el grado de efectividad en una escala del 10 al 0. Se recogieron los efectos adversos e incidencias relativas al tratamiento. En el análisis se utilizó para los valores descriptivos la mediana y el rango intercuartílico y la prueba de Wilcoxon para la comparación pre y postratamiento. Resultados: Se recogieron 22 pacientes con hemangiomas en distintos estadios evolutivos, obteniéndose una mejoría estadísticamente significativa tanto en el conjunto de todos los pacientes como en los distintos subgrupos. Cuatro pacientes presentaron incidencias postratamiento: edema y ulceración, atrofia cutánea e hiperpigmentación. Conclusiones: Consideramos que el láser dual de LCP y Nd:YAG puede ser una alternativa para el tratamiento de hemangiomas infantiles cuando las terapias consideradas de primera línea se muestran ineficaces o están contraindicadas (AU)

Background and objectives: Infantile hemangiomas are the most common benign tumor in children. They have 3 phases of development: a proliferative phase, an involuting phase, and involution. Although active treatment is often not required, it is necessary in some cases. Of the possible treatments for hemangiomas, lasers have been shown to be effective in all phases of development. We report our experience with dual-wavelength sequential pulses from a pulsed dye laser and an Nd:YAG laser. Material and methods: This was a retrospective, descriptive study of patients with infantile hemangioma in different phases of development treated with pulsed dye laser pulses followed by Nd:YAG laser pulses. Four dermatologists assessed the effectiveness of treatment on a scale of 10 to 0. Adverse effects and incidents related to treatment were recorded. The median and interquartile range were calculated as descriptive statistics. Pretreatment and posttreatment comparisons were performed using the Wilcoxon test. Results: Twenty-two patients with hemangiomas in different phases of development were included. A statistically significant improvement was obtained both for the entire group and for different subgroups. Posttreatment events were reported in 4 patients, and included edema and ulceration, skin atrophy, and hyperpigmentation. Conclusions: We believe that treatment with dual-wavelength light from a pulsed dye laser and a Nd:YAG laser is a viable treatment option for infantile hemangiomas when first-line therapies are ineffective or contraindicated (AU)

Infantile hemangiomas treated by sequential application of pulsed dye laser and Nd:YAG laser radiation: a retrospective study.

BACKGROUND AND OBJECTIVES: Infantile hemangiomas are the most common benign tumor in children. They have 3 phases of development: a proliferative phase, an involuting phase, and involution. Although active treatment is often not required, it is necessary in some cases. Of the possible treatments for hemangiomas, lasers have been shown to be effective in all phases of development. We report our experience with dual-wavelength sequential pulses from a pulsed dye laser and an Nd:YAG laser. MATERIAL AND METHODS: This was a retrospective, descriptive study of patients with infantile hemangioma in different phases of development treated with pulsed dye laser pulses followed by Nd:YAG laser pulses. Four dermatologists assessed the effectiveness of treatment on a scale of 10 to 0. Adverse effects and incidents related to treatment were recorded. The median and interquartile range were calculated as descriptive statistics. Pretreatment and posttreatment comparisons were performed using the Wilcoxon test. RESULTS: Twenty-two patients with hemangiomas in different phases of development were included. A statistically significant improvement was obtained both for the entire group and for different subgroups. Posttreatment events were reported in 4 patients, and included edema and ulceration, skin atrophy, and hyperpigmentation. CONCLUSIONS: We believe that treatment with dual-wavelength light from a pulsed dye laser and a Nd:YAG laser is a viable treatment option for infantile hemangiomas when first-line therapies are ineffective or contraindicated.

Venous malformations treated with dual wavelength 595 and 1064 nm laser system.

BACKGROUND & OBJECTIVE: Venous malformations (VM) represent a localized error in the embryological development of the venous branch of the circulation. The management of VM is complex and challenging. The aim of this study was to assess the efficacy and safety of combined sequential pulsed dye laser (PDL)-Nd:YAG laser in patients with cutaneous or mucosal VM. METHODS: Thirty patients (age from 8 to 65 years) with cutaneous or mucosal VM treated with dual wavelength PDL-Nd:YAG laser were retrospectively analyzed. Laser parameters were 10 mm spot size with 10 ms pulse and 8-10 J/cm(2) of PDL, followed with a second delay by Nd:YAG with 15 or 20 ms at 35-70 J/cm(2); or 7 mm spot size with 10 ms pulse and 5-10.5 J/cm(2) of PDL, followed with a second delay by Nd:YAG with 15 or 20 ms at 50-100 J/cm(2). Laser sessions were repeated approximately every 2-6 months. Air cooling was applied during treatment. Three dermatologists evaluated treatment effectiveness by means of photographs of the patients before and after laser treatment (scale from 0 to 4). Differences in the degree of clinical improvement between patients with cutaneous or mucosal VM were also assessed. Adverse events were registered. Patient satisfaction was also assessed in 19 cases (scale from 0 to 10). RESULTS: Mean global improvement was rated as 3.37. Mean improvement in patients with cutaneous VM was 3.35 and 3.38 in patients with mucosal VM. No significant difference between both groups was observed (P = 0.53). Long-lasting side effects included partial epilation of the eyelashes in one patient, ulceration in two patients and permanent scarring in three patients. Mean patient satisfaction was 8.55. CONCLUSIONS: Our study concludes that dual wavelength PDL-Nd:YAG laser was effective for treatment of the superficial component of cutaneous and mucosal VM.

Ablative fractional yttrium-scandium-gallium-garnet laser for scarring residual haemangiomas and scars secondary to their surgical treatment.

BACKGROUND: Infantile haemangiomas are benign self-involuting tumours. They have a characteristic clinical course marked by early proliferation and followed by spontaneous involution. However, residual evidence with scar formation, fibrofatty residua, atrophic wrinkling, yellowish discoloration and telangiectasias is usually seen after involution. OBJECTIVE: The aim of this study was to assess the efficacy and safety of ablative fractional yttrium-scandium-gallium-garnet (YSGG) laser in patients with residual haemangiomas or with scarring after their surgery. METHODS: Twelve patients with atrophic scar or fibrofatty tissue secondary to residual hemangiomas or with scarring after surgery of haemangioma were treated with one or two sessions of ablative fractional YSGG laser at 2.790-nm wavelength. Laser therapy was performed using a spot size of 300 µm, a pulse width of 600 ms, a fluence range between 120 and 200 mJ per microspot and a density level of 3. Treatment with PDL at 595-nm or with combined sequential 595 nm PDL and 1064 nm Nd:YAG was applied if telangiectasias or a residual vascular component were present. Three dermatologists evaluated treatment effectiveness by means of photographs of the patients before starting and 3 months after finishing the therapy; the degree of improvement was rated from 0 to 4. Parents' satisfaction was also assessed (scale from 0 to 10). RESULTS: Improvement was rated as 3 in two patients, 2 in four patients, 1 in five patients and no improvement in only one patient. Mean improvement was 1.58. Degree of parents' satisfaction ranged from 0 to 10. Mean satisfaction was 6.75. A discrete punctuate pattern was seen in three patients as the only long-lasting side-effect. CONCLUSION: We consider that ablative fractional YSGG laser could be an interesting option for the treatment of selected patients with atrophic wrinkling or scarring residual haemangiomas and scars secondary to their surgical treatment.

Keratosis pilaris rubra and keratosis pilaris atrophicans faciei treated with pulsed dye laser: report of 10 cases.

BACKGROUND: Keratosis pilaris rubra (KPR) and keratosis pilaris atrophicans faciei (KPAF) are both keratinization disorders characterized by erythema and keratotic follicular papules usually located on cheeks, forehead, chin and eyebrows. Topical keratolytics, vitamin D3 analogues, antibiotics, topical and oral retinoids have been used with limited results. As this condition can be socially very limiting, the need for an effective treatment has led to the use of other technologies such as pulsed dye laser (PDL) or intense pulsed light. OBJECTIVE: The aim of this study was to assess the efficacy and safety of PDL in patients with KPR or KPAF. METHODS: Ten patients with KPR or KPAF were treated with two to seven sessions of PDL at 595-nm wavelength. Laser therapy was performed using a spot size of 7 or 10mm, a pulse duration of 0.5 or 1.5ms and a fluence from 5 to 9J/cm(2) . Two dermatologists evaluated treatment effectiveness by means of photographs of the patients before starting and after finishing the therapy. RESULTS: Complete resolution of erythema was achieved in three patients; clearance of erythema was >75% in the other seven patients. Transient purpura was present in all patients for about 2weeks and one patient presented postinflammatory hyperpigmentation for 7months. CONCLUSION: We consider that PDL is a good option for the treatment of KPR and KPAF. A marked reduction in erythema is achieved in all patients with a low incidence of side effects.