Treatment of hereditary haemorrhagic telangiectasia by the pulsed dye laser

Abstract

Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome, Osier's disease) is an inherited abnormality of the vasculature characterized by abnormal subepithelial vessels. Treatment has included repeated intranasal cautery, intra-arterial embolization and arterial ligation.Treatment has included repeated intranasal cautery, intra-arterial embolization and arterial ligation. Historically, the operation of septodermoplasty and the use of systemic/topical oestrogens have been the most effective and lasting treatments, but over time the telangiectasias recur. There is increasing interest in the use of a variety of lasers for intranasal photocoagulation.A report of nine patients suffering from hereditary haemorrhagic telangiectasia who have undergone laser treatment with the Chromos pulsed dye laser is presented. This laser produces light energy at a wavelength of 585 nm and causes localized thermal damage to the blood vessel wall.Initially, no patient saw an improvement in their symptoms, but following an average of approximately three courses of treatment, all have reported a measurable reduction in the number of epistaxes suffered.Although no treatment completely resolves the epistaxis associated with this condition, we have found the pulsed dye laser to be effective at treating telangiectasias within the anterior nasal cavity.

Hereditäre hämorrhagische Teleangiektasie (Morbus Osler)

“…Im Gegensatz zu einem negativen, früheren Bericht [25] über die Therapieerfolge liegen jetzt auch ermutigende Behandlungsergebnisse mit diesem System vor [24]. Dieses Risiko ist bei Verwendung des gepulsten Farbstofflasers bei reduzierter Eindringtiefe wahrscheinlich geringer.…”

“…Dieses Risiko ist bei Verwendung des gepulsten Farbstofflasers bei reduzierter Eindringtiefe wahrscheinlich geringer. Möglicherweise beruhen die negativen Erfahrungen [25] auf ungünstig gewählten Laserenergieparametern [71] oder es wurden zu wenig Sitzungen durchgeführt [24]. Es ist interessant, dass es zum einen bei der Behandlung nicht zu einer vaskulären Abblassung wie bei den meisten anderen Lasern, sondern zur Zerreißung der Gefäße und bläulich-schwarzen Verfärbung der behandelten Stellen in Folge des ausgetretenen Blutes kommt.…”

Evidence-based management of epistaxis in hereditary haemorrhagic telangiectasia

“…33,34 The pulsed dye laser has also been shown to be of some benefit for treating lesions in several small studies in both surgical and out-patient settings. 35,36 There is evidence supporting the use of laser treatment for telangiectatic lesions in the nose to reduce the severity and incidence of epistaxis (level IV). However, there is insufficient evidence to support a particular modality of laser therapy.…”

Orofacial hereditary haemorrhagic telangiectasia: high power diode laser in early and advanced lesion treatment

“…Muco-cutaneous telangiectasia are the most obvious sign of the disorder, but it lacks specificity. The classical telangiectasia is a punctiform lesion 1-3mm in diameter and sharply separated from the surrounding skin 15 . They are most frequently found in the oral cavity with percentages of 58-79% 16 .…”