Sunday, October 10, 2004

Early Treatment Of Haemangiomas Using The Long Pulsed Dye Laser With Cryogen Spray Cooling

Taro Kono, MD, Yuji Kikuchi, Tsutomu Kashimura, Motohiro Nozaki, and Ali Riza Ercocen, MD.

Objectives: Childhood haemangiomas are nonmalignant vascular tumors that enlarge by rapid cellular proliferation. The efficacy of dye laser treatment of vascular lesions has been well established. In the present study, we aimed to demonstrate the efficacy of the long-pulsed dye laser (LPDL) equipped with cryogen spray cooling (CSC) in the treatment of early haemangiomas. Materials and Methods: 17 patients (7 male and 10 female) aged 6-16 weeks with early haemangiomas with Fitzpatrick skin types of III-IV were enrolled in this study. A long-pulsed dye laser equipped with a CSC system (V-beam, Candela Corporation, Wayland, Mass, U.S.A) with a wavelength of 595 nm, spot size of 7 mm was used. Fluences between 9 to 15 J/cm2 and pulse durations of 1.5 to 20 milliseconds were used. CSC device was fixed to 20-millisecond delay and 40-millisecond duration. Treatments were repeated every 4 weeks until the lesion cleared, stopped proliferating, stopped responding, or if the parents discontinued treatment. At the age of 12 months, all patients were evaluated for the degree of improvement by two independent clinicians. Results: Four patients had complete clearance , 7 had excellent (>75% clearing), 6 had good (50-75% clearing), and 2 had fair (25-50% clearing) improvement. There was no , poor (<25% clearing) response. The average of maximum proliferated time period is 108.1 47.3 (mean SD) days. Hypopigmentation and hyperpigmentation were observed in 2 patients. Scar and ulcer formation were not seen during the course of laser treatment. Conclusions: Owing to long-pulse width and cryogen spray cooling, we could use higher fluence and destroy large vessels with less epidermal damage. Less epidermal damage can be expected to result in fewer complications from laser treatment. To start laser treatment in early stage, there is a possibility to prevent the proliferation of haemangiomas. A prospective study including a half side test is necessary to determine the efficacy and complications of long-pulsed dye laser treatment of haemangiomas.
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