Treatment of leg telangiectases with a 532 nm KTP laser in multipulse mode

Photocoagulation of dermal blood vessels with multiple laser pulses in an in vivo microvascular model

BACKGROUND/OBJECTIVES

Current laser therapy of port wine stain (PWS) birthmarks with a single laser pulse (SLP) does not produce complete lesion removal in the majority of patients. To improve PWS therapeutic efficacy, we evaluated the performance of an approach based on multiple laser pulses (MLP) to enhance blood vessel photocoagulation.

STUDY DESIGN

The hamster dorsal window chamber model was used. Radiant exposure (RE), pulse repetition rate (f(r)), total number of pulses (n(p)), and length of vessel irradiated were varied. Blood vessels in the window were irradiated with either SLP with RE of 4-7 J/cm(2) or MLP with RE per pulse of 1.4-5.0 J/cm(2), f(r) of 0.5-26.0 Hz, and n(p) of 2-5. The laser wavelength was 532 nm and pulse duration was 1 ms. Either a 2 mm vessel segment or entire vessel branch was irradiated. Digital photographs and laser speckle images of the window were recorded before and at specific time points after laser irradiation to monitor laser-induced blood vessel structural and functional changes, respectively.

RESULTS

We found that: (1) for a SLP approach, the RE required to induce blood vessel photocoagulation was 7 J/cm(2) as compared to only 2 J/cm(2) per pulse for the MLP approach; (2) for MLP, two pulses at a repetition rate of 5 Hz and a RE of 3 J/cm(2) can induce photocoagulation of more than 80% of irradiated blood vessel; and (3) irradiation of a longer segment of blood vessel resulted in lower reperfusion rate.

CONCLUSIONS

The MLP approach can induce blood vessel photocoagulation at much lower RE per pulse as compared to SLP. The 5 Hz f(r) and the need for two pulses are achievable with modern laser technology, which makes the MLP approach practical in the clinical management of PWS birthmarks.

Laser treatment of superficial leg veins: a review

BACKGROUND

Superficial leg veins affect millions of people worldwide, and treatment of these vessels is a common dermatologic request. The advance of lasers in recent years has led to numerous laser and light devices intended to treat these superficial vessels.

OBJECTIVE AND METHOD

A review of the literature on the laser and light devices available for the treatment of superficial leg vessels with historical and recent trends is presented.

RESULTS AND CONCLUSIONS

The appropriate choice of light system to treat telangiectases, venulectases, and reticular veins varies depending on anatomical, physiological, and biological differences in the vessels. Safe and efficacious treatment of superficial leg vessels can be achieved with multiple lasers by taking advantage of the oxyhemoglobin absorption peaks. The authors have indicated no significant interest with commercial supporters.

Current concepts: laser treatment of adult vascular lesions

Patients frequently seek treatment of cutaneous vascular lesions for both medical and cosmetic reasons. Advances in the use of lasers and light sources enable physicians to effectively treat vascular lesions that were previously untreatable. Given the plethora of devices available, selecting the appropriate laser system and treatment parameters can be confusing for the laser surgeon. This article reviews current concepts in the treatment of adult vascular conditions. It highlights the different types of lasers and the most common vascular lesions amenable to therapy. Also, the article offers several pearls regarding selection of the laser and of the treatment parameters.

Laser therapy of spider leg veins

BACKGROUND

Spider leg veins are a common aesthetic problem in females. The standard treatment is sclerotherapy but lasers have been used for decades to solve this problem as well.

AIM

To review recent advances in laser physics and its tissue interactions with skin vessels. The different laser types used to treat spider leg veins are discussed, including their advantages, limitations and possible adverse effects.

METHOD

The international literature on laser therapy for spider leg veins has been reviewed with particular emphasis on the last decade.

RESULTS

Recent developments in laser technology allow a more selective and well-tolerated therapy. Efficacy has also improved. Most studies report a greater than 75% improvement in spider leg veins as a realistic goal for laser therapy. Clinic response depends upon wavelength, fluence, pulse width and pulse duration, cooling and the diameter and colour of spider leg veins.

CONCLUSIONS

Sclerotherapy remains the gold standard treatment for spider leg veins. Nevertheless, laser therapy has become increasingly efficacious and convenient. Laser selectivity has been improved by technological progress. The ideal laser, however, has yet to be invented.

Laser Treatment of Vascular Lesions

Lasers and other light sources have been developed that remove or improve many vascular lesions that were previously untreatable. Port-wine stains are the most notable example. Vascular lasers and light sources represent a major advance in dermatology for cosmetic and non-cosmetic applications. This article reviews the common vascular conditions amenable to laser therapy and the approaches and devices used.

Using silicone gel sheet for the treatment of facial telangiectasias with sclerotherapy

BACKGROUND

Telangiectasias are superficial cutaneous vessels that are visible to human eye and are present as a dilated venule, capillary, or arteriole. They are a common cause of concern, especially when located in face. Sclerotherapy is among the treatment alternatives, but facial telangiectasias are less responsive than those located on the leg.

OBJECTIVE

To show the effectiveness of silicone gel sheet in improving the results obtained by sclerotherapy in facial telangiectasias.

METHODS

Between 1998 and 2003, 32 patients were treated with sclerotherapy and silicone gel sheet (group 1). Twenty-six patients were treated with sclerotherapy and cotton ball (group 2), and 30 patients were treated only sclerotherapy (group 3). Patients were evaluated for 12 weeks for the degree of improvement and side effects. All complications, side effects, and number of sessions were also recorded at each follow-up visit. The number of sessions is limited to six. After the final follow-up visit, the photographs taken of each treatment site at baseline and at final visit were reviewed in a double-blinded manner based on a 0 to 4 scale by two physicians.

RESULTS

Fifty one of the 88 patients showed improvement totally. In the silicone sheet-sclerotherapy group, 22 of the 36 patients showed improvement. In the sclerotherapy-cotton ball group, 14 of the 26 patients showed improvement, and in the sclerotherapy-only group, 15 of the 30 patients showed improvement completely within the 12 weeks. The patients treated with sclerotherapy-silicone gel sheet (group 1) had more improvement than the other groups.

CONCLUSION

Combining silicone gel sheeting to sclerotherapy increases the success rate in treating facial telangiectasias, especially facial subunits, which have bone support.