Pulsed dye laser treatment of capillary malformations in infants at 2‐weekly versus 3‐monthly intervals, reducing the need for general anaesthesia

Abstract

Capillary malformations (CM) cause significant psychosocial complications. Pulsed dye laser (PDL) treatment at 6-12-weekly intervals under general anaesthesia (GA) commencing in infants at 6 months of age remains the standard of care in order to achieve maximal improvement prior to school age. The safety of repeated GA in children is controversial. Shortening the time between treatments increases the number that can be delivered prior to 6 months of age, thus reducing the number of subsequent treatments needed under GA. We investigated the safety and effectiveness of more frequent PDL treatment of CM in infancy via a pilot, prospective patient-controlled study of 10 patients. Using 595 nm (Vbeam) PDL, the entire CM was treated initially, then half the CM randomly allocated to 2-weekly and half to 3-monthly intervals for two further treatments. Photographs of the CM taken 3 months after treatment completion were evaluated by an independent, blinded dermatologist. Nine infants completed the study. Three infants (33%) had more improvement on the 2-weekly treated side and four (44%) had more improvement on the 3-monthly treated side. Two patients (22%) showed no difference between sides. Treatments were well tolerated without complications. We conclude that 2-weekly PDL treatments of CM in infants aged under 6 months is effective and well tolerated without adverse effects. Our preliminary data suggest a possible superior efficacy with 3-monthly treatment intervals; however, larger studies are warranted for stronger evidence. More frequent non-GA treatment of CM in infants should be further investigated to decrease the risk of repeated GA exposure in young children.

Clinical outcome measures and scoring systems used in prospective studies of port wine stains: A systematic review

“…Five studies (5.9%) were placebo-controlled. Thirty-two percent (N = 28/85) of studies was randomized (i.e., randomization of treatments to different patients or to different sites within one patient and/or PWS) [ 11 , 31 , 36 , 39 , 41 – 59 , 61 , 62 , 81 , 92 , 103 ]. Of the uncontrolled (noncomparative) studies (N = 42/75 [ 63 – 69 , 71 – 80 , 82 – 91 , 93 – 102 , 104 – 108 ]), 11 were performed to correlate, develop, or validate an instrument or analysis technique (such as laser speckle imaging; intended for measuring lesion characteristics, treatment effects, or efficacy), 1 study investigated different clinical assessment methods, and 1 study correlated PWS characteristics and demographic parameters with treatment results.…”

“…of studies was randomized (i.e., randomization of treatments to different patients or to different sites within one patient and/or PWS) [11,31,36,39,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]61,62,81,92,103]. Of the uncontrolled (noncomparative) studies (N = 42/75 [63][64][65][66][67][68][69][71][72][73][74][75][76][77][78][79][80][82][83][84][85][86][87]…”

Epidemiological study of capillary malformation among 7299 infants under 1 year of age in China

“…The onset of proliferation in patients with PWSs was mainly in patients older than 12 years old, and hypertrophy rarely occurred in patients younger than 20 years old in a previous study 21 . The PWSs without hyperplasia were relatively easy to treat 23–25 . Therefore, it further proved that it was meaningful to give patients with PWSs the correct interventions and treatments as soon as possible after their diagnosis was confirmed.…”

Pulsed‐Dye Laser Treatment of Port‐Wine Stains in Children: Useful Tips to Avoid General Anesthesia

“…We tend to start treatment of port‐wine stains as soon as possible and at short intervals of 1–4 months. During the first year of life it is easier, safer, and more effective to treat children without GA, because they have thinner skin with less melanin and the total treatment area is much smaller . There is some evidence suggesting a long‐lasting negative effect of painful procedures performed early in life, but we believe that the benefit of treating the vascular malformation earlier outweighs the potential risks .…”