Retrospective clinical comparison of hemangioma treatment by flashlamp-pumped (585 nm) and frequency-doubled Nd:YAG (532 nm) lasers.

BACKGROUND AND OBJECTIVE: Laser therapy using the flashlamp-pumped pulsed dye laser (FPDL), along with contact cryotherapy, has proven to be an effective method with few side effects in the early treatment of superficial hemangiomas in infancy. The long-pulsed frequency-doubled Nd:YAG laser (VersaPulse) is a new kind of laser whose efficacy and safety we examined in direct comparison with the FPDL. STUDY DESIGN/MATERIALS AND METHODS: In a retrospective comparative study, we treated 50 infants with a total of 62 superficial hemangiomas. A total of 29 hemangiomas were treated with the FPDL (wavelength 585 nm, impulse duration 0.3-0.45 msec), 33 with the VersaPulse (wavelength 532 nm, impulse duration 1-50 msec). With an average of 3.0 and 2.6 treatments (FPDL/VersaPulse respectively), a cessation of growth or regressive tendency could be achieved in 93% and 70% of the hemangiomas, respectively. Complete regression occurred in 41% (FPDL) or 30% (VersaPulse). Only in 7% (FPDL) or 18% (VersaPulse) was there progression despite laser therapy. The side effect rates of both laser systems were low. CONCLUSION: The FPDL has proven to be the slightly more effective treatment method in comparison and, therefore, remains the therapy of choice for the initial treatment. If parents wish to pursue further treatment in the regression phase of hemangiomas to optimize the cosmetic appearance, we recommend the VersaPulse due to its low rates of side effects and painfulness.     

Introduction of the flash-lamp pulsed-dye laser treatment of facial port-wine stains in childhood: A case of health care technology assessment

BACKGROUND AND OBJECTIVE: Lasers have been used in the treatment of port-wine stains (PWS) for more than 30 years. With the introduction of the flash-lamp pulsed-dye laser (FPDL) it was assumed that infants could be treated safely, effectively, and probably more efficiently. Nowadays, FPDL treatment is an established form of treatment of PWS in childhood. STUDY DESIGN/MATERIALS AND METHODS: On the basis of the iterative Health Care Technology Assessment (HCTA) loop, we examined whether sufficient evidence from evaluations has been present to support the introduction of FPDL treatment for facial PWS at an early age. Such an assessment requires an interdisciplinary approach focusing on aspects of safety, efficacy, effectiveness, quality of life, costs, and the ethical issues of treatment. RESULTS: Assessment of the FPDL in PWS treatment of children did not follow the model of medical innovation and evaluation. Most assessments have been focused on laser applications that were already in clinical use. Efficacy and effectiveness of laser treatment have been the major concern in most assessments. Only a few studies have looked at costs and ethical aspects of treating children. CONCLUSIONS: The introduction and diffusion of the use of the FPDL in the treatment of PWS in childhood were uncontrolled, and the field was not prepared to use this technique properly. We believe that this nonadherence to the iterative HCTA model reflects the gradual way by which innovations find their way into clinical practice.     

Flashlamp pulsed dye laser (FPDL) did not cure papulopustular rosacea

BACKGROUND AND OBJECTIVES: Pharmacological treatment has a fairly good effect on the papulopustular lesions in rosacea, but not as good an effect on the erythema and telangiectases. The aim was to treat rosacea patients with both erythematotelangiectatic and papulopustular lesions with flashlamp pulsed dye laser (FPDL) until telangiectases/erythema disappeared, and to evaluate whether the treatment might also be effective on papulopustular lesions. STUDY DESIGN/MATERIALS AND METHODS: Ten patients were treated on one side of the face with FPDL. The final examination was blinded and performed on the average 10 months after the last treatment. RESULTS: Two of the patients had more lesions after treatment, three were unchanged, three had only slightly less, and two had markedly less papulopustular lesions. CONCLUSION: Our conclusion from this small sample of patients is that FPDL probably has limited value on papulopustular lesions in rosacea. This indicates that the origin of rosacea may not be only vascular.     

Study of patient-reported morbidity following V-beam pulsed-dye laser treatment of port wine stains

The V-beam pulsed-dye laser (PDL) (595 nm) has gained popularity in the treatment of port wine stains (PWS). It uses longer pulse durations than the standard flashlamp-pumped pulsed-dye laser (FPDL) (585 nm) and has an in-built cooling system to protect the epidermis. This should, theoretically, reduce the treatment-associated side effects, including discomfort. The aim of this questionnaire-based study was to confirm the clinical impression that V-beam PDL is well tolerated. The results were compared with a historical group of 62 PWS patients treated with FPDL. Fifty-one patients took part in the current study. Only 35.7% (vs. 81% in the historical comparison group) required topical anaesthetic prior to laser treatment. A shortening in the duration of bruising (8 vs. 10 days) and of symptoms such as burning and tightness (3 vs. 10 days) was recorded. Lifestyle change after treatment was recorded by fewer patients (39 vs. 57%). We conclude that V-beam PDL is better tolerated than FPDL when used at therapeutic levels in patients with PWS.     

Clinical analysis of genital human papillomavirus infection in pregnancy

Objective: To determine the clinical characteristics, diagnosis and treatment of genital human papillomavirus (HPV) infection in the pregnant women and whether a woman with persistent HPV infection may get pregnant or not.Methods: Forty-five patients with genital HPV infection during pregnancy attending this hospital were analyzed retrospectively.Results: Among forty-five patients with genital HPV infection, 26 (58%) had genital warts, 18 (38%) had pathological changes but no symptoms and 1 (4%) was in a latent infection checked by HPV-DNA without symptom and pathological changes. 10 (22%) patients had other genital infections simultaneously. Only 16 (36%) of the patients had undergone the treatment of drug, laser, cryosurgery or surgery. 39 patients, including 3 patients with persistent HPV infection, had a full-term pregnancy. No respiratory papillomatosis cases were identified in any infants. In follow-up, 3 patients still had genital warts. 13 patients had thinprep cytologic test again and the results of 4 patients were abnormal. 5 patients had hybrid capture (HC2) again and 2 were positive.Conclusion: Respiratory papillomatosis cases were rare in the children with a maternal history of genital HPV infection during pregnancy. Pregnant women with genital HPV infection often had other genital infections. The patients with persistent HPV infection may try to get pregnant when virus burden is low.     

Pulsed dye laser and intralesional bleomycin for treatment of resistant viol hand warts

BACKGROUND AND OBJECTIVE: Viral warts affect 7-10% of the population and are a major burden on time and resources of dermatology departments everywhere. Some warts prove resistant to multiple therapies, and this is particularly common in the immunosuppressed patient. Numerous treatments are available, but no one treatment has emerged as the treatment of choice. Bleomycin has been shown to be effective in treating warts, but administration can be difficult with risk of local complications. To demonstrate a new technique for easily and safely administrating bleomycin into warts, we undertook an open study to assess the practicality, efficacy, and tolerability of pulsed dye laser immediately followed by intralesional bleomycin in resistant viral hand warts. STUDY DESIGN/MATERIALS AND METHODS: Ten subjects, all with resistant viral hand warts of at least 3 years duration were recruited. Four subjects were on long-term immunosuppressant drugs. Eighteen warts treated in total. Area of the wart was anaesthetized with 1% lignocaine, then treated with a pulsed dye laser (7 mm spot, fluence 10 J/cm2). Immediately following this bleomycin (0.5 IU/ml) was injected into the base of the wart. Monthly follow-up and treatment until satisfactory clearance. RESULTS: Sixteen out of eighteen warts cleared (89%). Eight out of ten warts in the immunosuppressed subjects cleared. The remaining two warts responded partially to two treatments, but the patient was happy with the result and did not wish further treatment. All warts in the immunocompetent subjects cleared. No serious side effects were seen. CONCLUSIONS: The initial treatment of the wart with pulsed dye laser serves to "prepare" the wart for the bleomycin injection, which can then be given very easily. This ensures the drug is deposited into the base of the wart where it is most needed and minimises the risk of infiltration of normal skin or the operative environment. This method of combining pulsed dye laser and intralesional bleomycin appears to be a safe, rapid, well tolerated, and successful treatment for resistant hand warts. It has proven to be effective in warts in immunosuppressed patients and at difficult sites (e.g., subungual warts). These findings need confirmation from a larger controlled study.     

Comparison of the flashlamp pulsed dye laser with the argon tunable dye laser with robotized handpiece for facial telangiectasia

This prospective study compares the efficacy, side effects, and patient acceptance of the flashlamp pulsed dye laser (FPDL) with the argon tunable dye laser with robotized handpiece (ATDL/H) for facial telangiectasias. Seventeen adult patients with bilaterally symmetric facial telangiectasias were enrolled. The right cheek on each patient was treated in one session with the FPDL at a fluence of 6.0–6.75 J/cm² and a spot size of 5 mm. The left cheek was treated at the same session with the ATDL/H at a power of 1 W, a fluence of 26–27 J/cm², and a hexagonal treatment area of 13 mm (127 individual 1 mm spots grouped mechanically by the handpiece). Patients were evaluated subjectively and by the investigators at 2, 4, and 6 weeks for blistering, swelling, bruising, changes in pigment, scarring, overall efficacy, and patient preference. Average treatment times were 5.4 minutes for FPDL and 9.4 minutes for ATDL/H. Blistering, crusting, and discomfort were completely resolved on both sides by week 2 in all patients. Bruising occurred in all patients with FPDL but had resolved in 62.5% of patients at 2 weeks and 100% at 4 weeks. There was no bruising with ATDL/H. Postinflammatory hyper-pigmentation was much more prominent with FPDL but had resolved in 88% of cases by week 6. As rated by the investigators 100% of the FPDL treated areas showed excellent clearing of telangiectasias, compared with 47% of ATDL/H treated areas. Despite better efficacy of the FPDL in clearing facial telangiectasias in one treatment, of the 15 patients with a preference 47% preferred the ATDL/H due to the marked bruising experienced with the FPDL. In conclusion, although the FPDL showed greater objective efficacy, the acceptable efficacy combined with the lack of bruising led almost half of the patients to prefer treatment with the ATDL/H. © 1993 Wiley-Liss, Inc.     

Long-term results in the treatment of childhood hemangioma with the flashlamp-pumped pulsed dye laser: an evaluation of 617 cases

BACKGROUND AND OBJECTIVE: Presenting the long-term results of flashlamp-pumped pulsed dye laser treatment in 617 hemangiomas to evaluate this treatment modality. STUDY DESIGN/MATERIALS AND METHODS: In 548 children, 692 hemangiomas were treated with the flashlamp-pumped pulsed dye laser (FPDL) SPTL 1B (Candela Corporation, Wayland, MA). The objective of treatment was the inhibition of further growth or the induction of regression. The treatment results were documented by the treating physician as well as by means of a questionnaire delivered to the parents. A total of 617 treatment results could be evaluated. RESULTS: After 1--12 treatments (mean, 2.5), we could achieve our treatment objective to stop the further growth of the lesion in 96.6% of all hemangiomas. In 13.8%, the treatment resulted in a complete remission, a significant regression was seen in 14.9%, and 67.9% of the treated lesions showed a discontinuation of growth. The percentage of complete remission was especially high in small superficial (42.6%) and superficial (19%) hemangiomas. CONCLUSION: In the vast majority of the hemangiomas, it was possible to stop further progression or induce regression by FPDL treatment. Total regression could be achieved in nearly half of the small superficial hemangiomas. Because the treatment is fast, effective, and nearly without side effects, we recommend early laser treatment especially in superficial and small childhood hemangiomas.     

Treatment of lupus erythematosus with pulsed dye laser

BACKGROUND AND OBJECTIVES: The treatment of cutaneous lupus erythematosus (CLE) with dye and argon laser has been evaluated in a number of articles in recent years. The improvement of telangiectasias and chronic erythema of the cutaneous lesions was based on the selective photothermolysis ablation of the dilated capillaries and venules. STUDY DESIGN/MATERIALS AND METHODS: We describe the results of the treatment of cutaneous lesions of 14 patients; eight with discoid lupus erythematosus (DLE) and six with systemic lupus erythematosus (SLE). Three patients received a treatment with flashlamp pulsed dye laser (FPDL) (585 nm, 450 microseconds) with fluences in the range from 5 to 7.75 J/cm(2); the other 11 patients were treated with long pulsed dye laser (LPDL) (595 nm, 1.5-10 milliseconds) with fluences in the range from 6 to 13 J/cm(2) depending on the pulse duration. RESULTS: During a median follow-up of 10 months, we observed an average improvement in over 60% of the lesions. A few side effects were observed in all patients: four had transient hyperpigmentation and one patient had light scarring. Three patients had a relapse after more than 1 year; they were then offered conventional treatment. CONCLUSIONS: We confirm that pulsed dye laser is a good alternative treatment for the erythema in active cutaneous lesions of lupus erythematosus (LE).     

Primary treatment of condylomata acuminata with viable bacillus Calmette-Guerin

PURPOSE: Condylomata acuminata or genital warts are caused by human papillomavirus. Prevalence data show that infection rates are increasing. To our knowledge we report the first successful primary treatment of genital warts with topical bacillus Calmette-Guerin (BCG) and provide long-term followup in a group of adjuvant treated patients with recurrent condylomata acuminata. MATERIALS AND METHODS: In 10 consecutive men viable BCG was directly applied to the condylomata acuminata lesions once weekly for 6 weeks. In nonresponding patients another course of 9 applications was administered for 3 weeks. RESULTS: A complete response was achieved in 6 of the 10 men after 1 or 2 treatment cycles. All responding patients are disease-free at a median followup of 9.2 months (range 4 to 12). One patient achieved partial regression of the lesions and in 3 the condylomata did not disappear. Side effects were rare and mild. Long-term followup in 6 adjuvant treated patients with rapidly recurrent condylomata acuminata showed no further recurrence after topical BCG in 5 at a median of 30.8 months (range 29 to 50). CONCLUSIONS: Topical application of viable BCG has therapeutic activity as adjuvant and primary treatment for penile condylomata acuminata with negligible side effects. Long-term followup implies the prevention of recurrent disease.     

男性健康人群和尖锐湿疣患者阴毛毛囊中人乳头瘤病毒的调查分析

目的:人乳头瘤病毒(human papillomavirus,HPV)在健康人群中广泛存在,但其在阴毛毛囊中的感染率目前尚不清楚,阴毛毛囊感染与尖锐湿疣的复发关系更不清楚,本课题旨在研究HPV在健康男性和尖锐湿疣患者阴毛毛囊中的感染情况,了解毛囊感染与尖锐湿疣复发的关系。方法:尖锐湿疣患者86例,年龄24~61岁,健康男性122例,年龄22~80岁,采用PCR技术对耻骨部阴毛毛囊中的HPV进行检测,并对两组资料进行分析。结果:男性尖锐湿疣患者的阴毛毛囊中HPV阳性率为32.55%(28/86),其中17例为HPV6(19.77%),7例为HPV11(8.14%),2例为其他亚型,混合感染2例(同时检测到HPV6和HPV11,以下同)。健康人群阴毛毛囊中的HPV检出率为17.21%(21/122),其中15例HPV6(12.30%),4例为HPV11(3.28%),1例其他亚型,1例为混合感染。结论:尖锐湿疣患者的阴毛毛囊中HPV感染率高于健康男性人群。尖锐湿疣患者与健康人群感染HPV的亚型基本相似,主要为HPV6和HPV11。     

Eccrine Syringofibroadenoma Treated with a Dual Pulse Width Flashlamp Pumped Pulsed Dye Laser

BACKGROUND: Eccrine syringofibroadenoma is a rare benign eccrine ductal proliferation with a predilection for the extremities, most often found in middle-aged and elderly patients. Reported treatments have included excision and conventional destructive modalities; however, recurrences may be common. OBJECTIVE: We describe a patient with a chronic ulcerated verrucoid eccrine syringofibroadenoma that persisted despite cryotherapy or curettage and electrodessication. RESULTS: Treatment with a dual pulse width flashlamp pumped pulsed dye laser (FPDL) produced an excellent clinical response. CONCLUSION: Treatment of eccrine syringofibroadenoma with a FPDL may provide both a vascular specific injury, analogous to the treatment of verruca vulgaris, and nonspecific thermal destruction at high fluences.     

Pulsed Dye Laser Treatment of Warts: An Update

BACKGROUND: Warts are a therapeutic challenge. New studies indicate that pulsed dye laser therapy may be effective, with clearance rates of 72 to 93%. OBJECTIVE: To determine clearance rate in pulsed dye laser treatment of warts and compare our rate to those of other published studies. METHODS: Thirty-three patients with 96 warts received pulsed dye laser treatment for recalcitrant plantar, digital, peri- and subungual, and body warts. RESULTS: Forty-eight percent of patients had complete wart clearance; 45% partially cleared. Sixty-nine percent of those who cleared remained wart-free for an average of 11 months. Mean fluence was 9.4 J/cm2, with an average of 3.4 treatments. Body and palmar warts responded best, digital and peri- and subungual next, and plantar lesions worst. No significant side effects were observed. CONCLUSION: Pulsed dye laser is an effective treatment option for recalcitrant warts with an excellent side effect profile. However, our response rates were not as high as those previously reported, and we feel that further studies would be useful.     

Correlations between light penetration into skin and the therapeutic outcome following laser therapy of port-wine stains

. For several years the flashlamp-pumped pulsed dye laser (FPDL) has been the favoured method for the treatment of port-wine stains (PWS). The therapeutic outcome of FPDL laser therapy depends on the anatomical location of the PWS and is mainly attributed to morphological parameters such as size and depth of the PWS blood vessels. The aim of this study was to show a correlation between the therapeutic outcome following FPDL therapy and the optical properties of the skin overlying the PWS vessels. For this purpose the therapeutic outcome following FPDL treatment (585 nm; 0.45 ms) of 884 PWS situated on different body sites was evaluated by judging the grade of fading of PWS colour. On the other hand the light penetration into 123 skin samples (thickness 0.10–1.35 mm) was determined between 450 nm and 1030 nm and compared with the PWS laser therapy outcome for equal locations by statistical analysis. PWS on the neck, trunk, arms or legs yielded a higher mean grade of fading as compared to PWS on the head. Within the face, a wide range of fading was evident. The light penetration into skin increased linearly with increasing wavelength and location-dependent differences were found. The attenuation coefficient was 22.8±5.3 mm⁻¹ at 585 nm. No significant or strong correlation was observed between the therapeutic outcome of PWS laser therapy and the light penetration into skin. However, a correlation was obvious by plotting the respective profile plots. Therefore, among other effects, in particular morphological parameters of PWS vessels, the optical properties of the skin contribute to a small extent to the clinical outcome of PWS laser therapy. Paper received 2 May 2001; accepted after revision 21 June 2001.     

Treatment of Anogenital Warts by Pulsed Dye Laser

BACKGROUND: Treatment of anogenital warts is difficult in that the disease spectrum is wide. Moreover, varying degrees of improvement are obtained. OBJECTIVE: To study the treatment of persistent anogenital warts by pulsed dye laser. METHODS: Pulsed dye laser was used with the following settings: spot size 7 mm, pulse duration 1500 microsec, and fluence 7.5 J/cm2. Two different wavelengths were used: 585 and 595 nm. RESULTS: Lesions healed completely using both wavelengths after one treatment. CONCLUSION: Pulsed dye laser has been found to be safe, effective, satisfactory, and less traumatic compared to other options for treatment of perianal warts in children.     

Pulsed dye laser therapy for viral warts.

Twenty-eight patients with 103 recalcitrant and 20 simple viral warts were treated with the Cynosure PhotoGenica V pulsed dye laser at 585 nm, and fluencies of 6.0-9.0 J/cm(2). An eradication rate of 92% for recalcitrant warts after an average of 2.1 (range 1-7) treatments and 75% for simple warts after an average of 1.6 (range 1-2) treatments was achieved with a mean follow-up period of 7.2 (range 3-15) months. Mild hypopigmentation was noted in one patient and superficial infection in another. Unlike ablative treatment modalities, with pulsed dye laser therapy, no wound was created thus avoiding prolonged postoperative pain, disability and scarring. Treatment was well tolerated by patients, most of whom returned to work or normal activities immediately postoperatively. Pulsed dye laser is an effective treatment for both recalcitrant and simple warts. It is the treatment of choice for these lesions in cosmetically sensitive areas.     

Experience with the early treatment of childhood haemangiomata using the flashlamp-pumped dye laser

Small cutaneous haemangiomata of infancy respond well to treatment with the flashlamp-pumped dye laser (FPDL). Optimum use of laser parameters can produce a regression in over 75% of such lesions. In very early lesions, a complete resolution can be achieved in up to 55% of cases. Since this therapy is quick and effective, and side-effects are minimal, FPDL treatment of all haemangiomas of infancy presenting early should be recommended, even if progression to deep haemangiomas cannot be prevented in all cases.     

Pulsed Dye Laser Treatment is Effective in the Treatment of Recalcitrant Viral Warts

BACKGROUND Verrucae vulgaris can be removed in a variety of ways but a specific therapy of choice has not yet been developed. Doctors are faced with a challenge, especially in the treatment of recalcitrant warts. It has been suggested that the success of pulsed dye laser treatment lies in the fact that warts contain an increased number of dilated blood vessels.
METHODS Seventy-three patients (42 female, 31 male) with verrucae vulgaris on their hands or feet (1:1.5) were given a maximum of 12 treatments with a flashlamp-pumped pulsed dye laser every 2 weeks over a period of 24 weeks until complete clearance had been achieved. A laser energy density of 8 to 12 J/cm² with a spot size of 5 mm and a pulse duration of 450 μsec were used. The minimum follow-up period was 6 months.
RESULTS A total of 15.1% patients achieved complete clearance after 1 session and 47.9% after 2 to 5 sessions, resulting in a remission of 63.0% patients after a maximum of 5 treatment sessions. A remission of 23.3% patients was seen after 6 to 9 treatments and a total of 89.0% of patients showed remission after a maximum of 10 sessions. Only three patients (4.1%) failed and five patients (6.9%) stopped the treatment on account of pain/noncompliance. Only one patient, from a group of patients treated between January 2003 and April 2004, has relapsed.
CONCLUSION Pulsed dye laser treatment is effective and safe in the treatment of recalcitrant viral warts.     

Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine: A Prospective Placebo-Controlled, Double-Blind Randomized Trial

BACKGROUND 5-Fluorouracil is an antimetabolite that has been known to be effective for the treatment of common warts.
OBJECTIVE The objective was to evaluate the efficacy of a combination of 5-fluorouracil, lidocaine, and epinephrine (5-FU+LE) for the treatment of common warts.
MATERIALS AND METHODS Of the 40 patients initially enrolled, 34 patients with at least 68 verruca vulgaris (one pair for each subject) completed the study. The selected warts were randomized into two treatment groups, with one wart on each patient receiving intralesional 5-FU+LE (4 mL of 50 mg/mL 5-fluorouracil and 1 mL of a mixture of 20 mg/mL [2%] lidocaine and 0.0125 mg/mL epinephrine) and the other receiving intralesional normal saline placebo using a Mantoux needle. Patients received up to four injections at weekly intervals and were followed at 1 and 6 months after the initial injection.
RESULTS Complete response was observed in 64.7% of the warts treated with 5-FU+LE compared to 35.3% in the warts treated with placebo ( p <.05). Systemic reaction or treatment-related adverse medical events and recurrence rate did not differ significantly between two groups.
CONCLUSION The results show that intralesional 5-FU+LE is a safe and effective approach for common warts with high success rate.     

Bowenoid papulosis at the site of prior herpes progenitalis

A 35-year-old dentist came to the authors' attention for papular and vegetating lesions that had appeared on his penile shaft over the last 2 months. The lesions differed in their features: pink and vegetating on the left side, brown and papular on the right side (Figure 1). The obvious clinical diagnoses of genital warts on the left and Bowenoid papulosis on the right were confirmed by punch biopsies, which showed epithelial hyperplasia with diffuse cell vacuolization (koilocytes)in the left biopsy and moderate nuclear dysplasia in the right one (Figure 2). Human papillomavirus phenotyping was not performed. Interestingly, the patient reported a clear medical history of herpes progenital is (only one episode) that had involved the right side of his glans and prepuce 4 years ago. An immunomodulating treatment with imiquimod was started in the attempt to cure both the genital warts and Bowenoid papulosis lesions (imiquimod was applied three times a week for 8 weeks). At the end of the treatment, the genital warts had disappeared, whereas many Bowenoid papulosis lesions were still present on the right side of the penis (Figure 3). Treated with liquid nitrogen as well, the Bowenoid papulosis lesions disappeared.