Flashlamp-pumped pulsed dye laser for port-wine stains in infancy: Earlier versus later treatment

“…Antes de iniciar el tratamiento se debe tener certeza del diagnóstico pues como ha sido mencionado anteriormente, si tratamos un hemangioma segmental con láser podemos inducir una ulceración. Aunque existen controversias acerca del momento más apropiado para iniciar la aplicación del láser, en general, se admite que debe ser lo más precoz posible 26 . Aquellos pacientes que reciban tratamiento temprano obtendrán un mayor beneficio del láser ya que en edades tempranas la piel es más fina y los vasos sanguíneos tienen un calibre más pequeño.…”

Section: Malformaciones Capilaresunclassified

Láser y luz pulsada intensa en el tratamiento de hemangiomas infantiles y malformaciones vasculares

Sánchez‐Carpintero

Mihm

Waner

2004

Anales Sis San Navarra

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RESUMENEl uso de las indicaciones del láser en el manejo de las malformaciones vasculares y los hemangiomas infantiles se fundamenta en la teoría de la fototermolisis selectiva, siendo la oxihemoglobina el cromóforo diana sobre el cual actúa la luz del láser, evitándose así el daño a tejidos vecinos. El láser de colorante pulsado es el más utilizado y es, actualmente, el tratamiento de elección en las malformaciones capilares (mancha en vino de Oporto). La respuesta obtenida es variable, alcanzándose un aclaramiento sustancial del color de la lesión, tras varias sesiones. La aplicación en edades tempranas parece mejorar los resultados. Las malformaciones venosas, especialmente las localizadas en la mucosa, responden mejor al láser de Nd:YAG; las malformaciones linfáticas al láser de CO 2 . Las malformaciones arteriovenosas raramente responden. El uso del láser de colorante pulsado en la fase proliferativa de los hemangiomas es controvertido, excepto si existe ulceración. En estos casos se obtiene una reepitelización rápida tras su empleo. En la fase involutiva, los pacientes con lesiones residuales vasculares pueden beneficiarse de otros láseres como KTP o Nd:YAG. Si presentan superficie atrófica y cicatrices mejoran con láser de CO 2 o Er:YAG. Están emergiendo nuevas modalidades como la terapia fotodinámica cuya eficacia y seguridad, tanto en el tratamiento de los hemangiomas como de las malformaciones vasculares, está aún por confirmar. ABSTRACTThe use of the indications of the laser in treating vascular malformations and infantile haemangiomas is based on the theory of selective photothermolysis, in which the oxyhaemoglobin is the target chromophore on which the light of the laser acts, thus avoiding damage to neighbouring tissues. The pulsed dye laser is the most employed and at present is the treatment of choice in capillary malformations (port-wine stains). A variable response is obtained, with a substantial clearing of the colour of the lesion after several sessions. Application at early ages seems to improve the results. Venous malformations, especially those localised in the mucosa, respond better to the Nd:YAG laser; lymphatic malformations to the CO2 laser. Arteriovenous malformations rarely respond. Use of the pulsed dye laser in the phase of proliferation of the haemangiomas is subject to controversy, except where there is ulceration. A rapid re-epithelialization is obtained in these cases following its use. In the involution phase, patients with residual vascular lesions can benefit from other lasers such as KTP or Nd:YAG. If they show an atrophic surface and scars these complications improve with the CO2 laser or Er:YAG. New treatment modalities are emerging, such as photodynamic therapy, whose efficacy and safety, both in the treatment of haemangiomas and vascular malformations, have yet to be confirmed.

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“…The pulsed dye laser produces reasonably good results in a select population of port wine stain patients owing to its ability to selectively destroy cutaneous blood vessels. [13][14][15] Nevertheless, very few patients achieve complete port wine stain blanching despite receiving multiple laser treatments. [16][17][18] Further, although there are some factors (including anatomic location, size, color, nodularity, and patient age), which appear to influence treatment response, to date, none of these has been accepted as a reliable prognostic indicator of therapeutic outcome.…”

Section: Mona M Selim Md Kristen M Kelly Md J Stuart Nelson Mmentioning

confidence: 99%

Confocal Microscopy Study of Nerves and Blood Vessels in Untreated and Treated Port Wine Stains: Preliminary Observations

et al. 2004

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Background and Objective. Vascular ectasia in port wine stain birthmarks (PWS) might result from reduced innervation with loss of autonomic stimulation. We investigated this theory and evaluated nerve and blood vessel density, and mean blood vessel size in untreated and treated PWS skin. Methods. Skin biopsy specimens were obtained from uninvolved skin, untreated PWS, PWS with a good response to laser treatment and PWS with a poor response to laser treatment. Confocal microscopy was performed to determine nerve and blood vessel density, and mean blood vessel size. Results. Nerve density was significantly decreased in all PWS sites compared to uninvolved skin. Mean blood vessel diameter was larger in untreated compared to treated PWS. PWS with a good response to treatment had decreased nerve density but blood vessel density and mean diameter was relatively normal. PWS with a poor response to treatment had decreased nerve density but increased blood vessel density and mean blood vessel diameter compared to normal skin. Conclusion. Nerve density was decreased in all evaluated PWS sites and this may be a factor in lesion pathogenesis. PWS blood vessel size correlated with pulsed dye laser response and may prove to be a useful prognostic indicator of therapeutic outcome.

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Flashlamp-pumped pulsed dye laser for port-wine stains in infancy: Earlier versus later treatment

Cited by 246 publications

References 30 publications

Description and Analysis of Treatments for Port-wine Stain Birthmarks

Description and Analysis of Treatments for Port-wine Stain Birthmarks

Láser y luz pulsada intensa en el tratamiento de hemangiomas infantiles y malformaciones vasculares

Confocal Microscopy Study of Nerves and Blood Vessels in Untreated and Treated Port Wine Stains: Preliminary Observations

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