Copper vapour laser treatment of port wine stains: clinical evaluation and comparison with conventional argon laser therapy

The copper vapour laser (CVL), emitting at 578 nm. offers potential advantages over the argon laser in the treatment of port wine stains (PWS). In this study, two test areas were performed with each laser using a Hexascan delivery system in 31 patients with PWS. One area was treated at minimal blanching fluence and one at 75% of this fluence. The pulse width was constant for each patient (mean 155 ms). Four-month assessments were made using a fading scale of 0–4. and objectively by an index of light absorbence using reflectance spectrophotometry. The CVL-treated sites had significantly better fading scores than argon laser-treated sites at minimal blanching fluence (P<0.005) and lower absorbence indices (P<0.05). Fading was significantly greater at minimal blanching fluence than at 75% of this fluence by fading scores and absorbence index values for both lasers. Slight textural and pigmentary changes were seen in a smafl minority of both CVL and argon tests at minimal blanching fluence only. This study indicates that the CVL is superior to the argon laser in treatment of predominantly red-purple or purple PWS. The minimal blanching technique produces greater fading than a lower energy fluence.     

The treatment of port wine stains with the carbon dioxide laser

The carbon dioxide (CO2) laser was used to treat 51 patients with port wine stains (PWS). Twenty-nine patients were adults who had failed to respond to argon or continuous wave dye laser therapy and 22 patients were children with pink PWS. Follow-up assessment of 40 patients 12 months after treatment revealed an excellent or good result in 74% of adults and 53% of children. The results in adult 'therapeutic failures' was encouraging and CO2 laser therapy can be advised for this group. Two children had a poor result, one with a hypertrophic scar, and treatment in this age group with the CO2 laser should be considered with caution.     

Comparative histochemistry of port-wine stains after copper vapor laser (578 nm) and argon laser treatment.

The present study compared the histologic changes occurring 15 min after copper vapor laser (CVL; operating at 578 nm) and argon laser (488/514 nm) treatment of port-wine stains (PWS) over a range of energy densities (8-32 J/cm2) with corresponding pulse widths of 50-200 ms. Frozen tissue sections were stained with nitroblue tetrazolium chloride (NBTC). This histochemical method permits an accurate color differentiation between blue-stained viable and unstained thermally damaged cells. At 8, 10, and 12 J/cm2 the argon-laser injury was confined to epidermal cell layers; none to superficial dermal effects were found. Fluences of at least 15 J/cm2 produced a diffuse NBTC-negative coagulation necrosis. Exposure of PWS skin to 8-12 J/cm2 at 578 nm did not alter the integrity of epidermal cells. In the dermis, damage was confined to blood vessels and surrounding collagen, showing a clear demarcation from adjacent viable structures. The maximum penetration depth achieved with these vessel selective energy densities was 0.44 mm. At 15 J/cm2, besides vascular injury, damage to the basal cell layer also occurred. At fluences of 17-20 J/cm2 a diffuse necrosis similar to that induced by the argon laser was found. Vessel selectivity of the 578 nm wave band was achieved with pulse widths from 50-74 ms, exceeding the estimated "ideal" exposure time (0.1-10.0 ms) for a vascular selective laser effect. The NBTC method allowed identification of subtle laser-induced tissue changes providing accurate quantitative data relating to the extent of vascular injury.     

Five years' experience of treating port wine stains with the flashlamp-pumped pulsed dye laser

Summary During the last 5 years, 640 patients had treatment to their port wine stains (PWS) with a flashlamp-pumped pulsed dye laser. One hundred and fifty-six patients have been discharged for varying reasons, of which 59 (38%) achieved excellent (at least 75%) lightening of their birthmark. Of the remaining patients, those who attended the clinic for the sixth and 12th time for treatment were also assessed to determine the degree of fading achieved in the port wine stain. Our findings confirm that flashlamp-pumped dye laser treatment is safe and effective for the treatment of PWS and that complications are rare. However, the degree of fading achieved is variable and often unpredictable. Fifty-two per cent of facial lesions of different colours achieved over 75% fading as against 18% of non-facial lesions. Sixty-four per cent of those over the age of 50 years had an excellent response whereas only 19% of those below the age of 5 years were able to achieve a similar result. The colour of the port wine stain was found to be of no prognostic value. A search for an accurate and non-invasive method to predict the outcome of flashlamp-pumped pulsed dye laser therapy for PWS is warranted.     

寻常疣脉冲染料激光治疗前后激光散斑成像观察

目的 采用激光散斑衬比分析（LSCA）技术无创性观察分析不同部位和大小的疣体激光治疗前后的血流变化,以探讨LSCA技术用于激光治疗寻常疣疗效量化评价的可能性。 方法 采用脉冲染料激光（PDL）治疗17例寻常疣患者30处病灶,使用LSCA观察和记录治疗前、治疗后10 min、治疗后3周疣体及其周围正常皮肤血流变化及散斑流速指数（SFI）值,以评估PDL治疗的效果。 结果 寻常疣患者治疗前疣体的血流SFI值（11.600 ± 1.190）高于周围正常皮肤（5.280 ± 0.481）,差异有统计学意义（t = 8.169,P < 0.01）。与治疗前疣体SFI值相比,治疗后10 min（3.112 ± 0.484）和治疗后3周时（7.315 ± 1.083）疣体血流SFI值均显著降低（t值分别为4.407、3.294,均P < 0.01）,治疗后3周高于治疗后10 min（t = 4.646,P < 0.01）。激光治疗后10 min疣体周围正常皮肤血流SFI值（20.260 ± 2.063）较治疗前显著升高（t = 6.770,P < 0.01）,但治疗后3周（4.941 ± 0.616）又较治疗后10 min显著降低（t = 6.964,P < 0.01）,治疗后3周与治疗前相比,差异无统计学意义（t = 0.378,P = 0.707）。激光治疗的效果与疣体大小和分布部位有关, < 0.5 cm2疣体激光治疗后血流改变较 ≥ 0.5 cm2疣体更大,差异有统计学意义（t = 2.287,P < 0.05）;不同分布部位的疣体激光治疗后血流改变不同（F = 15.71,P < 0.01）,不同部位疣体血流SFI值改变由大到小依次为手指、足背、足趾、掌跖、甲周。 结论 寻常疣疣体内血流较正常皮肤明显升高,PDL可以凝固气化疣体内血管达到治疗目的。利用LSCA血流监测技术,能定量观察到激光治疗寻常疣前后的血流变化。     

(18) The treatment of portwine stains with the tunable dye laser at 577 nm

The treatment of portwine stains (PWS) by lasers has become established as the treatment of choice in recent years. Most experience has been with the argon laser which emits predominantly at 488 and 514 nm. These wavelengths do not coincide with the absorption maxima of haemoglobin at 415, 542 and 577 nm. Light at 577 nm is particularly well transmitted through the epidermis and selectively absorbed by haemoglobin. We have been treating patients with PWS with a Coherent CR599 argon-pumped continuous wave tunable dye laser emitting at 577 nm.
Seventy-one patients with PWS have been treated in Leeds, mean age 36·9 years, range 11–61 years. Ninety-six per cent had PWS on the face or neck. The majority were treated under local anaesthesia; the longest follow-up has been 42 months.
The minimal blanching method was used¹ with a spot diameter of 1 mm, power range of 0·3 – 0·5 W in most patients, with a pulse duration of 0·5–2 s. Energy fluence was 38–63 J/cm².
Improvement in the treated area from partial to complete paling occurred in 75% with scarring in 5% which was usually atrophic, and minor pigmentary changes in 7%.
These results are comparable with the best series reported from argon laser therapy and confirm the theoretical advantage of treatment with laser light at 577 nm.     

Kinetics of the superficial perfusion and temperature in connection with photodynamic therapy of basal cell carcinomas using esterified and non-esterified 5-aminolaevulinic acid

BACKGROUND: Photodynamic therapy (PDT) is a local treatment modality with increasing indications for various malignant and non malignant diseases. The treatment parameters have not yet been optimized as there is a need for a better understanding of the process. The skin is an important target and serves as a good model for monitoring and evaluating the interaction of light with biological tissue. OBJECTIVES: The tissue perfusion and the temperature of basal cell carcinomas were measured in connection with PDT in order to investigate the biological mechanisms involved. METHODS: An infrared camera was used during the treatment to measure skin temperature and a laser Doppler perfusion imaging device was used to image the superficial perfusion before and after treatment. Six hours after topical application of 5-aminolaevulinic acid (ALA) or methyl esterified ALA (ALA-ME), 38 basal cell carcinomas were treated using light from a diode laser at 633 nm. RESULTS: In the lesions, the perfusion immediately after PDT was similar to that before PDT. One hour after the treatment the perfusion in the lesion was increased 50% compared with before PDT. However, in the skin surrounding the lesions the perfusion was doubled immediately after PDT and was still increasing 1 h after treatment. A temperature increase in the lesions of about 1-3 degrees C was observed for light fluence rates of 100-150 mW cm-2. In all patients treated, a diffuse temperature increase was visible outside the lesions. In some of the patients, the outlines of the blood vessels surrounding the treated lesions became visible in the thermal images. Measurements of temperature on healthy volunteers not administered photosensitizer, but illuminated with light of the same fluence rate, showed a similar increase in temperature in the illuminated spots. However, no temperature increase was observed outside the illuminated area. No statistically significant differences were found between the measurements on patients treated with ALA and ALA-ME. CONCLUSIONS: The increased perfusion in the area surrounding the lesions after PDT, as seen by perfusion and temperature measurements, is the result of an inflammatory reaction to the PDT process. However, directly after PDT the perfusion in the lesions was the same as before irradiation. The combination of these observations suggests the presence of local blood stasis during and immediately after the treatment. The temperature measurements showed that the increased temperature was well below the temperature limit of hyperthermal damage. Furthermore, the measurements indicate that the increase in temperature was primarily a consequence of the heat absorbed in the tissue.     

Flashlamp pulsed dye laser and argon-pumped dye laser in the treatment of port-wine stains: a clinical and histological comparison

BACKGROUND: Port-wine stains (PWS) are congenital vascular malformations occurring in 0.3% of children. The pulsed dye laser is a well established treatment for PWS. OBJECTIVES: To compare, clinically and histologically, the effects of the flashlamp pulsed dye laser with the argon-pumped dye laser in the treatment of PWS. METHODS: Thirty patients were treated on two to four test areas with both laser types using different energy fluences. A flashlamp pulsed dye laser with 0.45 ms pulse duration and a spot size of 5 mm was compared with an argon-pumped dye laser, with a spot size of 1 mm delivered with a robotic scanning laser handpiece (Hexascan) and 70-190 ms pulse duration. Both were tuned to 585 nm. Twelve weeks later the degree of lightening was evaluated and biopsies were taken. To count the vessels the skin sections were stained with CD34 using an immunohistochemical technique. The vessels were divided into three groups by diameter (d): d < 10 microm, 10 < or = d < 20 microm, d > or = 20 microm. RESULTS: The clinical results showed a significantly better lightening using the flashlamp pulsed dye laser than with the argon-pumped dye laser. The histological results showed a significant decrease in the number of vessels of diameter larger than 20 microm in treated compared with untreated lesions. We found no histological difference in the number of vessels between the two laser treatments. However, there was a tendency towards more small vessels (diameter < 10 microm) after one treatment with the flashlamp pulsed dye laser compared with untreated PWS. CONCLUSIONS: The flashlamp pulsed dye laser is clinically superior to the argon-pumped dye laser in the treatment of PWS.     

Objective assessment of port-wine stains following treatment with the 585 nm pulsed dye laser

Previous studies assessing the treatment of port-wine stains (PWS) with the 585 nm pulsed dye laser have relied on either subjective clinical assessment or in vivo measurement of skin colour alone. The aim of the present retrospective study was to develop an objective method of assessing available pre- and post-treatment photograph pairs. Port-wine stains depicted in photographs of 23 patients following six or more treatment sessions were assessed for changes in colour (DeltaH*) and PWS size by computer image analysis and were compared with a subjective assessment of PWS reduction by a "blinded" physician examining the same images. The post-treatment mean reduction in the PWS assessed by the physician was 39.7%. A global assessment score incorporating values of DeltaH* and PWS size by computer analysis showed a mean reduction of 12%, with a more significant correlation with the physician assessment (Spearman's rank correlation coefficient 0.627; P=0.001) than changes in size or colour alone.     

Treatment technics in argon laser therapy

This study compares 50 msec and 200 msec laser pulses with continuous application of the argon laser to test sites within port-wine stains (PWS). It also assesses the effects of different irradiance, energy fluence, and spatial average energy fluence on PWS lightening. Test areas responded with diminution of lesional color and lack of scarring as well as or better than to laser treatment by continuous exposure. Despite differences in irradiance and energy fluence for each laser impulse, the total energy delivered to all test areas was similar. There appeared to be no greater specificity for destruction of vascular structures conferred by using the short, 50-msec pulse duration. Operation of the argon laser with continuous irradiation leads to good clinical results, is less tiring and easier for the laser surgeon, allows larger areas to be treated more quickly, and often produces less mottling and more uniform PWS lightening than does pulsed irradiation.     

Demographic study of port wine stain patients attending a laser clinic: family history, prevalence of naevus anaemicus and results of prior treatment

All patients with port wine stains (PWS) attending a tunable dye laser clinic were examined by one author (SWL), forming a large group which has allowed study of the demographic data of such patients. Two hundred and eighty-three patients, 217 females (median age 24 years, range 0.5–73) and 66 males (median age 20 years, range 0.75–72), were examined. The PWS were on the face in 226, neck in 69, trunk in 36, upper limb in 35 and lower limb in 29. The commonest lesional colour was purple (63 patients), while 39 naevi were pink/red, 35 pink/purple and 35 pink. The naevus was flat in 255 patients, Cobblestoned in 28, associated with hypertrophy in 31 and with scarring in 22. Seventy-two patients (25.4%) had a positive family history of birthmarks, 20 strawberry haemangiomas and 22 PWS, the family history of PWS being higher than expected for the prevalence of this naevus in the population. One hundred and forty-six patients were also examined for naevus anaemicus which was noted in 12 (8.2%), confirming an association between these two naevi. Ninety-tour patients had received previous treatment, most commonly with the argon laser (56 patients), of whom only five reported a good result, and 17 of 22 patients with treatment-related scarring had been treated with this laser. Cosmetic camouflage was used in 109 (38.5%) of patients, who usually had PWS on the face (94%), of whom only 46 (16%) had received advice of its use.     

可变脉宽 Nd:YAG激光与强脉冲光治疗鲜红斑痣动物模型的研究

目的 通过动物模型研究可调脉宽Nd:YAG激光与强脉冲光对鲜红斑痣的治疗作用。方法 以38只莱亨鸡作为鲜红斑痣动物模型,随机分为4组,其中1组（2只）作为空白对照组不给予激光照射,其余3组（每组12只）分别给予可变脉宽Nd:YAG激光照射2次、强脉冲光照射2次、Nd:YAG激光和强脉冲光照射各1次,分别观察鸡冠形态学、组织学变化,对照射前后每高倍镜下血管数的变化进行统计学分析。结果 2次照射后,各组鸡冠被照射区颜色变淡,光镜下可见真皮血管层变薄,血管闭锁,血管数目减少。每高倍镜（ × 400）下血管数Nd：YAG照射组为（17.92 ± 3.63）个,强脉冲光照射组为（8.08 ± 1.56）个,联合照射组为（7.08 ± 1.31）个,与未照射的对照组（37.08 ± 3.97）个相比,各组血管数均减少,差异均有统计学意义（P < 0.01）。联合照射组与强脉冲光照射组比较,差异无统计学意义（P > 0.01）,但低于Nd:YAG组（P < 0.01）。结论 可变脉宽Nd:YAG激光照射、强脉冲光照射、两者联合照射均可用于鲜红斑痣的治疗。强脉冲光照射、二者联合照射治疗鲜红斑痣效果可能优于单独可变脉宽Nd:YAG激光照射。     

A prospective study of the impact of laser treatment on vascular lesions

BACKGROUND: Vascular lesions, especially on exposed sites, can be unsightly and may cause significant psychological distress. Lasers are effective in treating such lesions, but relatively few studies have been performed looking at psychological scoring before and after laser therapy. OBJECTIVES: To assess the change in psychological distress in patients with vascular lesions following laser treatment. PATIENTS AND METHODS: A prospective study was performed with patients recruited over a 3-month period. Psychological distress was measured using subjective scores on a standard questionnaire before treatment and at a 6-month follow-up. Each patient was treated every 4-8 weeks with an appropriate laser by the same dermatologist until discharge. Forty-two patients were recruited with one of four diagnoses: telangiectasia, port wine stain (PWS), vascular spider or cherry angioma, which occurred mainly on facial or exposed sites. RESULTS: Following laser treatment, there was a significant decrease in subjective scores of patients with telangiectasia and vascular spiders. Patients with PWS showed objective improvement but this was not reflected in their subjective scores. Psychological distress had reduced significantly in patients with less severe vascular lesions. CONCLUSIONS: Laser treatment of minor vascular lesions leads to objective improvement, which is paralleled by psychological benefit, but objective benefit in PWS may not be perceived as beneficial by patients.     

Potassium titanyl phosphate laser treatment of resistant port-wine stains

BACKGROUND: The pulsed dye laser (PDL; 585 nm, 450 micros pulse) has been established as the treatment of choice for port-wine stains (PWS), but only few patients have total clearance. A modulated potassium titanyl phosphate (KTP) laser (532 nm) has been developed that allows the adjustment of energy fluences within the 5-50 J cm-2 range with laser pulse widths between 1 and 50 ms at pulse rates from 1 to 20 pulses s(-1). OBJECTIVES: To determine the efficacy and side-effect rate of the KTP laser in treating PDL-resistant PWS. METHODS: Thirty patients were recruited. The site and colour of the PWS were recorded and assessed with erythemameter readings, videomicroscopy and photography both before and after treatment. All patients had test areas treated on their first visit and were then reviewed at 2-monthly intervals. Repeat treatments were given if no adverse effects had occurred and if the treated areas had shown between 25 and 100% lightening. RESULTS: Thirty patients were assessed, age range 11-63 years (mean 35.4) with 19 females. The PWS affected the face in 21 (70%) patients, leg in five (17%) and other sites in four (13%). Patients had one to four tests or treatments (mean 2.2) with the KTP laser. Overall, 16 (53%) patients showed > 25% response and five (17%) showed > 50% response to treatments with the KTP laser. Best responses were found with fluences ranging from 18 to 24 J cm(-2) with pulse width 9-14 ms. No correlation was found with the colour of the PWS or the number of previous treatments with PDL. Patients preferred the KTP laser treatments compared with the PDL (visual analogue score mean 9.8; n = 5) with less discomfort during treatments and minimal purpura post-treatment. Six patients (20%) developed side-effects: scarring (n = 2, 7%), hyperpigmentation (n = 3, 10%) and prolonged healing phase of over 4 weeks (n = 1, 3%). CONCLUSIONS: We have shown that the KTP laser can further lighten PDL-resistant PWS and that it is a useful addition to the laser treatment of PWS. Further studies need to assess the efficacy and side-effects of the KTP laser in previously untreated PWS.     

Results and tissue healing after copper-vapour laser (at 578 nm) treatment of port wine stains and facial telangiectasias

Twenty-four patients with port wine stains (PWS), and 33 patients with facial telangiectasias were treated with a copper-vapour laser (CVL) operating at 578 nm. Good to excellent results were obtained in 52% of PWS and 69% of facial teiangiectasias. Enzyme histochemistry revealed vessel-selective damage with energy densities up to 12 J/cm², but a non-specific coagulation necrosis with higher fluences (≥ 15 J/cm²). With vessel-selective fluences only moderate blanching was obtained in two PWS. All other evaluated patients were treated using non-selective energy densities. Tissue healing was comparable with that after argon laser treatment. The theoretically correct wavelength (578 nm) alone appeared to be no guarantee of vessel-selective damage. The laser employed laeked adequate power (only 1.3 W maximum) to transmit sufficient energy into the tissues in a short exposure time. However, the clinical results confirm the value of the CVL in the treatment of superficial cutaneous angiodysplasias.     

预测双波长脉冲染料激光治疗鲜红斑痣效果的无创模型研究

目的:建立一种预测脉冲双波长染料激光治疗鲜红斑痣效果的无创数学模型。方法:收集采用双脉冲染料激光治疗的91例面颈部鲜红斑痣患者资料,将其分为建模组(59例)及验证组(32例)。在建模组采用单因素及多因素方法分析影响PWS治疗效果的独立相关因素;通过logistic回归建立数学模型PWS index;最后采用ROC曲线下面积、敏感性、特异性等评价该模型的疗效预测能力。结果:经单因素及多因素方法分析发现皮肤镜表现分型、B超皮肤厚度是预测染料激光治疗面颈部鲜红斑痣治疗效果的独立相关因素(P<0.05)。数学模型PWS index=-5.899+[-1.846(皮肤镜表现1型)/2.017(皮肤镜表现2型)]+6.808*B超厚度。PWS index预测建模组及验证组鲜红斑痣治疗效果的曲线下面积分别为0.952(95%CI:0.895,1.01)、0.902(95%CI:0.785,0.102)。结论:皮肤镜表现、B超皮肤厚度是预测染料激光治疗鲜红斑痣疗效的独立相关因素,基于二者建立的数学模型PWS index在建模组及验证组均显示出较好的疗效预测价值。     

The effects of antipsoriatic treatment on cutaneous blood flow in psoriasis measured by 133Xe washout method and laser Doppler velocimetry

In 8 patients with psoriasis vulgaris, the cutaneous blood flow (CBF) was measured simultaneously in both involved and uninvolved psoriatic skin before (i.e., on the first day of hospitalization) and on the 3rd, 7th, 14th, and 28th days of treatment with tar. The 133Xe washout method was used after epicutaneous labeling and compared to the laser Doppler velocimetry (LDV) technique. Control experiments were performed in 10 normal individuals. Before treatment the mean CBF in involved psoriatic skin was 62.6 +/- 18.7 SD ml X (100 g X min)-1, which is significantly higher than CBF of uninvolved skin in psoriatic patients, 9.5 +/- 4.0 SD ml X (100 g X min)-1, (p less than 0.01) and is 13.6 times higher than CBF in the normal individuals (p less than 0.01). Fifty hours following onset of treatment (i.e., after only 2 applications of tar), mean CBF of the involved psoriatic skin had decreased significantly to 35.0 +/- 13.9 SD ml X (100 g X min)-1, (p less than 0.01), which was not statistically different from the CBF on the 7th day. During the following weeks, the CBF in involved psoriatic skin decreased at a more moderate rate than that observed during the first week and was 15.0 +/- 6.1 SD ml X (100 g X min)-1 on the 28th day. This value is not significantly different from the CBF of uninvolved skin in these patients. At the end of treatment, the CBF of the uninvolved skin had decreased significantly (p less than 0.05) in all the patients to values similar to those observed in the skin of normal individuals. A parallel decline was observed in a clinical psoriatic score index; however, it is not known whether the observed decrease in CBF was preceded or succeeded by the clinical improvement. A comparison of the 133Xe measurements and LDV measurements in the normal individuals by linear regression analysis yielded a correlation coefficient of -0.24 (N = 20, p greater than 0.05). In the skin of psoriatic patients the correlation coefficient was 0.01, (N = 47, p greater than 0.05) for unaffected skin, and 0.61 (N = 47, p less than 0.001) in the involved psoriatic skin sites. The LDV measurements did not reflect changes in the uninvolved skin in psoriatic patients during treatment and resulted in a remarkably high C.V. in the bilateral measurements of skin in normal individuals (43.8%) compared to the C.V. of 133Xe flow measurements (14.8%). It is concluded that while the LDV method gives a rough estimate of blood flow in cutaneous tissue with a high capillary perfusion rate, inaccurate measurements are made in skin areas with normal to twice the normal CBF range.     

Successful treatment of discoid lupus erythematosus with argon laser

Vascular lesions with telangiectasias on visible areas, such as the face, are common in discoid lupus erythematosus (DLE); however, an efficient management of these skin lesions can sometimes be difficult. Since argon laser light is able to specifically coagulate vascular structures, it has been used in the treatment of various vascular skin malformations. Therefore, we addressed the issue whether argon laser treatment could be a therapeutic alternative for this disease. Here, we report on a patient with DLE, who suffered from long-standing erythematous, telangiectatic plaques on the face refractory to standard regimens of therapy. After 2 laser applications, a significant improvement was observed and after 5 sessions of argon laser therapy the treated skin lesions had completely resolved with an excellent cosmetic result. The patient tolerated the laser treatment well without any short-term side effects. These data indicate that argon laser therapy might be a powerful alternative approach in the treatment of vascular skin lesions of DLE.     

Venous lakes (Bean-Walsh) of the lips—treatment experience with the argon laser and 18 months follow-up

The intense blue-green light of the argon laser has proven very effective in the treatment of a great variety of vascular skin disorders. Venous lakes (Bean-Walsh) of the lips are blood-filled dome-shaped lesions, their treatment often requiring surgery. Fifty-one patients suffering from this disorder were treated with the argon laser with 1.5-2.0-mm spot size, 0.3-s pulse duration and 1.8-3.0-W power. In most cases treatment was carried out without local anaesthesia. Laser impact was followed immediately by shrinking of the lesions and replacement by a whitish-grey plaque. Excellent cosmetic results were obtained in 90% of the patients. Three patients showed mild scarring. At 18 months follow-up only one patient showed a recurrence. The argon laser appears to be a highly effective non-invasive treatment modality for venous lakes of the lips.     

Cutaneous lupus erythematosus-treatment with pulsed dye laser

Because of its vascular selectivity, the flashlamp-pumped pulsed dye laser (585 nm) is efficacious in the treatment of vascular lesions and is successfully used for the treatment of port-wine stains and haemangiomas in children. Based on the encouraging results with these cutaneous vascular disorders, the cutaneous lesions of patients with lupus erythematosus (LE) have now also been treated with the pulsed dye laser. Cutaneous lesions in lupus erythematosus are often difficult to treat with readily available local therapeutic methods. We report here on a group of 12 patients whose LE lesions were treated with the pulsed dye laser. In 10 patients, the LE was limited to the skin, while two patients had systemic LE (SLE). Even in the two patients with SLE, a significant improvement of skin lesions was achieved. After a mean number of 51 laser sessions, a median clearance rate of 70% was attained for nine patients. In one case, the laser treatment failed to clear the lesions. Two patients did not show any visible improvement of the lesions, but pain and itching were significantly reduced. There were few side-effects. No prolonged laser-induced scarring occurred and in only two patients was hyperpigmentation seen, which had resolved completely after 4 and 5 months, respectively. During a median follow-up of 7 months (range: 3-32 months), only one patient (after a complete clearance of the skin lesions) had a small relapse. In summary, the pulsed dye laser is an effective therapy for the treatment of superficial skin lesions in LE.