Side-effects and complications of flashlamp-pumped pulsed dye laser therapy of port-wine stains. A prospective study

The flashlamp-pumped pulsed dye laser (FPDL) was the first laser system specifically developed for the treatment of cutaneous vascular lesions such as port-wine stains (PWS), tckmgiectases and haemangiomas. Its theoretical advantages have been verified by numerous excellent clinical results As there are few systematic studies on the adverse effects of this laser system, we investigated 100 consecutive patients who received FPDL therapy of PWS. Pain during and after laser therapy was a common complaint. Post-treatment erythema occurred in 29%. oedema in 73%. formation of hullae in 1%, and serous crusting in 46–83% of patients (based on our observations and the patients histories, respectively), all of which lasted for a maximum of 7 days. Furthermore, complications such as impetigo-like crusting occurred in 25%, bleeding in 12%. a pyogenic granuloma in 1%. hyperpigmentation in 27%, hypopigmentation in 1%, atrophic scarring in 3%, and an liypertrophic scar in 1%. Although most of these changes were only focal, and were predominantly transient, our results indicate that the incidence of side-effects and complications produced by the FPDI. (wavelength 585 nm, pulsewidth 450μs) may be higher than previously documented in the literature.     

400例儿童皮肤血管异常疗效分析

目的 探讨低体重儿与血管瘤发生的关系及染料激光单用和联合药物皮损内注射治疗皮肤血管异常的疗效分析。方法 对209例婴儿血管瘤患儿和100例正常儿童自身健康情况及母孕期情况进行问卷调查分析。 脉冲染料激光治疗毛细血管瘤、微静脉畸形、蜘蛛痣、化脓性肉芽肿的疗效分析。脉冲染料激光联合药物皮损内注射治疗混合性血管瘤进行临床疗效分析。结果 209例婴儿血管瘤患儿低体重儿占33.49％,正常对照组低体重儿占9％。两组比较差异有统计学意义（u = 4.621,P ＜ 0.05）。脉冲染料激光治疗仪治疗毛细血管瘤有效率达到83.69％、治疗微静脉畸形有效率达到92.59％、治疗蜘蛛痣有效率达到100％、治疗化脓性肉芽肿有效率达到50％。脉冲染料激光联合药物皮损内注射治疗混合性血管瘤有效率达到95.59％。结论 低体重儿与血管瘤的发生关系密切。脉冲染料激光治疗毛细血管瘤、微静脉畸形、蜘蛛痣疗效显著。脉冲染料激光联合药物皮损内注射治疗混合性血管瘤疗效更显著。     

Rapid remission of severe pruritus from angiolymphoid hyperplasia with eosinophilia by pulsed dye laser therapy

A 48-year-old Japanese woman with angiolymphoid hyperplasia with eosinophilia (ALHE) was successfully treated with a flashlamp pulsed dye laser (585 nm, 450 micros pulse duration). The lesion was severely pruritic and had been enlarging slowly for 2 years but was resistant to conventional therapies, including topical, intralesional, and systemic corticosteroid, and cryotherapy. The severe pruritus immediately improved after the first treatment using the pulsed dye laser. The erythema and papules gradually improved without scarring and this was followed by further five treatments over approximately a 4-month interval. No clinical recurrences have been observed 1 year after completion of the treatment. We think that pulsed dye laser therapy is an effective treatment for ALHE in both Japanese as well as Caucasian patients. Pulsed dye laser therapy is also helpful in reducing the pruritus in ALHE patients.     

The combined continuous-wave/pulsed carbon dioxide laser for treatment of pyogenic granuloma.

BACKGROUND: Pyogenic granuloma is a frequently diagnosed, benign vascular lesion. OBJECTIVES: To present the use of the combined continuous-wave/pulsed carbon dioxide (CO2) laser as an innovative therapeutic method, to compare it with established methods, and to assess its results. DESIGN: Prospective observational study between March 1998 and July 2000, comprising 1 treatment session with 6-week and 6-month follow-up examinations and evaluations. SETTING: Private or institutional practices as well as ambulatory or hospitalized care. PATIENTS: One hundred patients with pyogenic granuloma selected from a population-based sample. INTERVENTIONS: Treatment with CO2 laser. The laser was first used in continuous mode (power, 15 W) and then in pulsed mode (pulse length, 0.6-0.9 milliseconds; energy fluence, 500 mJ/pulse). MAIN OUTCOME MEASURE: Complete resolution of treated granuloma pyogenicum. RESULTS: Pyogenic granuloma was removed completely in 1 treatment session in 98 patients without recurrence. In 88 cases there were no visible scars; in 10 cases slight textural changes of the skin were observed. Hypertrophic scars or keloids did not occur. Sixty-three patients were very satisfied with the result of the treatment, 37 were satisfied (ie, 100% patient satisfaction), and none indicated that they were not satisfied. No permanent hypopigmentation, hyperpigmentation, or erythema was observed. CONCLUSIONS: The combined continuous-wave/pulsed CO2 laser is our treatment of choice for pyogenic granuloma because this kind of laser is widely available, produces excellent results with few adverse effects, is easy to use, yields low recurrence rates, and is well tolerated by most patients.     

Recurrent pyogenic granuloma with satellitosis

The development of recurrent pyogenic granulomas as multiple satellite lesions is rare and often associated with trauma or treatment of the primary lesion. At least 34 cases of such lesions after various treatment modalities have been reported, but none occurred in conjunction with laser therapy. We report a case of recurrent pyogenic granuloma with satellite lesions that developed after carbon-dioxide laser excision of a previously recurrent lesion.     

Pyogenic Granuloma in Ten Children Treated with Topical Imiquimod

Abstract:  Traditional therapy for pyogenic granuloma is procedural. In young children it can require a general anesthetic and may be complicated by scarring, dyspigmentation, and recurrence. We report a series of 10 children, highlighting the safety and efficacy of topical 5% Imiquimod as an alternative noninvasive treatment of pyogenic granuloma. Ten children with a mean age of 2.5 years and 10.8 week duration of facial pyogenic granuloma lesion were recruited. Treatment regime with topical Imiquimod 5% cream varied in frequency of application and duration according to clinical response. Clinical outcome in the majority of the children was satisfactory. Three had no evidence of disease and five had small hypopigmented or erythematous lesions which were continuing to improve and more acceptable then a surgical scar. One child required a prolonged treatment course, and one progressed to surgical excision when prolonged treatment failed. There were no systemic side effects noted in any of the patients and no recurrence noted with resolution sustained over an average of 9.6 months of follow-up. Imiquimod is a safe, cost-effective, and clinically effective management option in the treatment of pyogenic granuloma.     

Pyogenic granuloma complicating pulsed-dye laser therapy for cherry angioma

A 37 year-old-woman presented for cosmetic removal of a 7-mm (diameter) cherry angioma on her right anterior thigh. Various treatment options were discussed and removal of the lesion using pulsed-dye laser was carried out. The patient returned 5 weeks later complaining of bleeding from the treatment site, which on examination showed a 23 × 23-mm friable nodular lesion with the typical appearance of a pyogenic granuloma. This lesion was removed by shave excision, curettage and electrodessication. Histopathological examination confirmed the diagnosis of pyogenic granuloma. This is a rare occurrence post pulsed-dye laser therapy that physicians may choose to discuss with patients prior to performing this procedure.     

Dye laser treatment of periungual pyogenic granuloma

Treatment of pyogenic granuloma may be difficult in locations such as the face and fingertips. We successfully treated a 1 cm periungual fingertip pyogenic granuloma with a dye laser.     

Eruptive pyogenic granulomas: a successfully treated patient and review of the literature

Summary Pyogenic granuloma, also known as lobular capillary haernangioma, is a solitary, benign vascular skin tumour. Although a single pyogenic granuloma is common, multiple eruptive pyogenic granulomas are extremely rare.
We report the occurrence of multiple, eruptive pyogenic granulomas in a previously healthy 17-year-old girl. Over 200 lesions appeared spontaneously over an 8-month period. Lesions were initially treated with cryolherapy, and then with the pulsed dye laser, resulting in their complete clearance.     

Extragenitaler Lichen sclerosus et atrophicus – Behandlung durch gepulsten Farbstofflaser

A 17-year old female patient with extragenital lichen sclerosus et atrophicus was treated with the pulsed dye laser. Local and systemic therapy before treatment showed no effect. The lesions were removed completely with four treatment sessions. As for side effects, no pigment changes and no visible scarring was observed. The patient experienced no recurrence within a follow-up time of 7 months. The mechanism whereby lichen sclerosus et atrophicus is altered by the pulsed dye laser is unknown.     

Pyogenic Granuloma in a 5‐Month‐Old Treated with Topical Timolol

A 5‐month‐old healthy female presented with a pyogenic granuloma on the cheek. The lesion was treated with topical 0.5% gel‐forming solution, resulting in regression of the lesion after 1 month of treatment and no recurrence at 8 months. This case suggests that treatment of pyogenic granulomas with topical timolol may be considered, especially when other treatment modalities are challenging or could result in significant scarring.     

Effectiveness of topical propranolol 4% gel in the treatment of pyogenic granuloma in children

Pyogenic granuloma is a benign acquired vascular tumor that affects the skin and mucous membranes, occurring more often in children and young adults. Treatment is often required due to the associated risk of ulceration and bleeding. There are several publications reporting the use of beta‐blockers for the treatment of pyogenic granuloma. The aim of the present study was to evaluate the clinical effectiveness and safety profile of topical propranolol 4% gel for the treatment of pyogenic granuloma. A retrospective study of all cases of pyogenic granuloma treated with topical propranolol 4% gel between 2014 and 2015 was performed. Epidemiological, clinical and treatment data, including effectiveness score and safety, were reviewed. Of a total of 18 patients with pyogenic granuloma, 11 (61.1%) showed complete resolution of the lesion while two (11.1%) had an almost complete response. In three cases (16.6%), the treatment was discontinued due to bleeding, and the lesions were removed by curettage. Local irritation and lack of compliance led to treatment discontinuation in two cases. Altogether, 13 out of 18 patients (72%) had complete or almost complete response to treatment. There was a correlation between treatment duration and response to treatment. One patient only reported local side‐effects including irritation, redness and scaling of the treated area leading to discontinuation of the treatment and curettage of the pyogenic granuloma. No systemic adverse effects were reported. This is an uncontrolled retrospective study. Propranolol 4% gel may be considered as a safe and efficient topical therapy for pyogenic granuloma.     

Successful treatment of a therapy-resistant pyogenic granuloma with topical imiquimod 5% cream

A 58-year-old man was referred to our department for evaluation and treatment of a therapy-resistant pyogenic granuloma on his right third digit. This biopsy-confirmed lesion was unsuccessfully treated with shave excision and base electrocautery on two separate occasions before the patient presented to our clinic. After completing a 14-week course of twice-weekly imiquimod 5% topical application, this patient's pyogenic granuloma completely resolved. A satisfactory cosmetic outcome was also achieved, with virtually no scarring.     

Treatment of facial vascular lesions with intense pulsed light

BACKGROUND: Various lasers, particularly the flashlamp-pulsed dye laser, have been proven to be effective in the treatment of facial vascular lesions. Nevertheless, the post-treatment side effects, such as pronounced purpura and changes in pigmentation, have been a matter of concern to patients. OBJECTIVE: To test the efficacy of an alternative treatment option that uses intense pulsed light to provide patients with a more tolerable post-treatment outcome. METHODS: A total of 200 patients were treated with an intense pulsed light source (PhotoDerm ® VL) using various treatment parameters. The patients were treated for facial veins (primarily telangiectasia), facial hemangiomas, rosacea and port wine stains. RESULTS: Of the 188 patients who returned for follow-up after 2 months, 174 achieved 75% to 100% clearance in one to four treatment sessions. The post-treatment side effects were minimal and well tolerated by the patients. There were no instances of scarring or other permanent side effects. CONCLUSION: The PhotoDerm ® VL provides a highly effective and safe alternative to the laser for treatment of facial vascular lesions. The device may achieve improved results for lesions that are resistant to laser therapy. The rate and degree of cosmetic side effects are considerably less than with laser treatment.     

Segmentaler Morbus Darier

Darier disease is often associated with pruritus and an unpleasant odor, causing medical and emotional problems. Ablative laser therapy has proven effective in ameliorating these symptoms. Side effects of this approach include permanent hypopigmentation and a risk of scarring. We present two cases where non-ablative therapy with pulsed dye lasers proved a safe and effective way to manage the intertriginous lesions. Although the mechanism of action is unclear, our success indicates that pulsed dye laser therapy is an option in Darier disease. Larger numbers of patients, ideally in multicenter studies, must be treated in this way to confirm our results.     

Cryotherapy in the treatment of pyogenic granuloma

BACKGROUND: Pyogenic granuloma is a benign, acquired, proliferative vascular lesion of the skin and mucous membranes. Many different treatments have been used for pyogenic granuloma with variable success rates. OBJECTIVE: To evaluate the efficacy of cryotherapy in the treatment of pyogenic granuloma. METHODS: In a prospective observational study, 135 patients with pyogenic granuloma were treated with cryotherapy using liquid nitrogen. The patients were followed up every 3 weeks until 3 months after disappearance of the lesion. RESULTS: Complete resolution of the pyogenic granuloma was achieved in all patients after a mean of 1.58 treatments (range, 1-4 treatments). At the end of follow-up period, there was a flat imperceptible scar, smaller than the treated lesion, in 16 patients (11.8%). A hypertrophic scar, 3 mm in diameter, was observed in one patient. Hypopigmentation was observed in seven patients (5.1%). No other complication or side-effect was recorded in the study. CONCLUSIONS: We believe that pyogenic granuloma can be treated simply and effectively with cryotherapy.     

Treatment of granuloma faciale with the pulsed dye laser

Granuloma faciale is a chronic benign vasculitis that generally affects the skin of the face. The lesions are commonly refractory to therapy. A patient with long-standing granuloma faciale refractory to topical corticosteroid and dapsone therapy had an excellent response to treatment with the pulsed dye laser.     

Effectiveness of combined pulsed dye and Q‐switched ruby laser treatment for large to giant congenital melanocytic naevi

Summary Background There is no consensus on the most appropriate treatment for patients with large to giant congenital melanocytic naevi (CMN) because of the risk of melanoma development. Surgical excision followed by skin grafting or expanded skin coverage may cause unfavourable scarring. There is a balance to be achieved between minimizing the disfiguring appearance and the risk of malignant change. The pulsed dye laser (PDL) is commonly used for vascular lesions and is highly absorbed by melanin and haemoglobin. Its pulse duration is longer than that of Q‐switched ruby lasers (QsRL), which can have nonspecific photothermolytic effects on surrounding nonpigmented naevus cells. Objectives To investigate the effectiveness of combined treatment with the PDL and QsRL for large to giant CMN. Methods Six patients with large to giant CMN were enrolled in this study. Treatment consisted of one pass of PDL treatment followed by one pass of QsRL treatment. Multiple rounds of treatment were applied to all patients. Results All patients responded to this combined regimen, and the lesional colour was effectively reduced. The mean number of rounds of laser treatment required to achieve skin lightening was 7·7. No patients suffered severe hypertrophic scarring. No cases of recurrence or malignant transformation were observed. The histological results from the patient who underwent the most laser therapy in this study showed a remarkable reduction in the number of melanocytic naevus cells after treatment. Conclusions This technique may enable the removal of most of the pigmented lesion and melanocytic naevus cells with minimal scarring.     

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.     

Pulsed dye laser treatment of port-wine stains in pigmented skin

BACKGROUND: Little information is available on pulsed dye laser treatment of darker Fitzpatrick skin types. METHODS: We retrospectively reviewed our clinical experience treating mainly facial (12/13) port-wine stains (PWSs) in 13 patients of skin type V, whose ages ranged from 3 to 65 years. RESULTS: The response was excellent in 2 patients, good or moderate in 4 each, slight in 1, and poor in 2. Hyperpigmentation occurred in 6 patients and hypopigmentation in 1, which improved despite continuing treatment. Limited atrophic scarring developed in two patients. Although these results were less good and side effects more frequent than described in skin types I to IV, 6 patients (46%) achieved a good or excellent response and 85 (87.6%) of the total 97 laser treatments were not associated with significant problems. CONCLUSION: Patients of skin type V with a PWS should not be excluded from pulsed dye laser therapy, provided that treatment expectations and risks are fully discussed.