1
|
Won P, Cooper M, Justin Gillenwater T, Yenikomshian HA. Treatment of Hypertrophic Burn Scars With Laser Therapy: A Review of Adverse Events. Ann Plast Surg 2023; 91:715-719. [PMID: 37856225 PMCID: PMC10840736 DOI: 10.1097/sap.0000000000003712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
ABSTRACT Hypertrophic scarring, characterized by excessive scar tissue formation, is a debilitating outcome that significantly impairs physical and psychosocial recovery after burn injury. Hypertrophic scarring affects a substantial proportion of burn survivors, with reported prevalence as high as 70%. Fractional CO 2 laser (FCL) therapy, a therapy commonly used in acne scar treatment or skin rejuvenation, has become popular in treating hypertrophic scars. Little is known regarding FCL's adverse events for burn scar treatment. We hypothesize that FCL is a safe treatment modality with minimal adverse events in the management of hypertrophic burn scars. This is a retrospective chart review of adverse events after FCL at 2 centers within a single institution. Burn patients undergoing FCL between May 1, 2019, and June 1, 2021 were included. Demographics, injury etiology, laser treatment details, and adverse events were collected. A total of 170 patients, 77 (45.3%) males and 93 (54.7%) females, underwent 544 FCL therapies for burn scars. The average number of treatments per patient was 3 ± 2.23, with a range of 1 to 17 sessions. From the total 544 laser therapy sessions, 13 adverse events (2.4%) were reported. There were 5 reports (0.9%) of increased postprocedural pain and 1 report (0.2%) of increased paresthesia/numbness to laser site. Three instances (0.6%) of increased erythema and 4 reports (0.7%) of epidermal sloughing or blistering were reported. All but 5 patients (2.9%) reported improvements to scar symptoms. This study demonstrates minimal adverse events associated with FCL for hypertrophic burn scar treatment.
Collapse
Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Cooper
- LAC+USC Hospital, University of Southern California, Los Angeles, CA, USA
| | - T. Justin Gillenwater
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Haig A. Yenikomshian
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
3
|
Su WT, Xue JX, Ke YH. Noteworthy effects of a long-pulse Alexandrite laser for treatment of high-risk infantile hemangioma: A case report and literature review. World J Clin Cases 2019; 7:1876-1883. [PMID: 31417934 PMCID: PMC6692259 DOI: 10.12998/wjcc.v7.i14.1876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/03/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We have previously proved that treatment of thick/deep infantile hemangiomas (IHs) with a long-pulse Alexandrite laser was clinically effective and safe. This article aims to investigate the efficiency of long-pulse Alexandrite laser use in treating thick and high-risk IHs located in particular anatomic areas and provides some new data on this issue.
CASE SUMMARY A two-month-old girl with a thick and high-risk IH covering most of the right labia majora was examined in this study. The infant received four treatment sessions at 4- to 6-wk intervals with a long-pulse Alexandrite laser with settings as follows: 3 ms pulse duration, 8 mm spot size, 45 to 50 J/cm2 fluences, and dynamic cooling device (DCD) spray duration of 90 ms with a delay of 80 ms. Following each of the four treatment sessions, the IH showed a remarkable reduction in thickness and size without any sign of relapse. Ten months after the last treatment, the IH had completely regressed without adverse effects. During the laser treatment, no severe side effects were observed; blistering occurred only immediately after treatment and then scabbed over the next day, gradually improving in the following days.
CONCLUSION Long-pulse Alexandrite laser treatment may be considered one of the first-line noninvasive therapeutic options for the treatment of thick IH.
Collapse
Affiliation(s)
- Wen-Ting Su
- Medical Cosmetology Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou Skin Disease and Plastic Surgery Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Ji-Xin Xue
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - You-Hui Ke
- Medical Cosmetology Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou Skin Disease and Plastic Surgery Hospital, Wenzhou 325000, Zhejiang Province, China
| |
Collapse
|
4
|
Waibel JS, Holmes J, Rudnick A, Woods D, Kelly KM. Angiographic optical coherence tomography imaging of hemangiomas and port wine birthmarks. Lasers Surg Med 2018; 50:718-726. [PMID: 29566276 DOI: 10.1002/lsm.22816] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A current therapeutic challenge of vascular lesions is that they do not always respond effectively to laser treatment. Information on targeted vessels could potentially be used to guide laser treatments. Optical coherence tomography (OCT) is a useful tool for the non-invasive imaging of tissues, including skin hemangiomas and port wine birthmarks. Dynamic OCT is able to rapidly characterize cutaneous blood vessels. The primary goal of this study was to demonstrate the ability of bedside OCT to image (i) overall vessel pattern; (ii) individual vessel morphology, diameter and depth; and (iii) total vessel density as a function of depth in infantile hemangiomas and port wine birthmarks (PWB). MATERIALS AND METHODS This IRB approved, observational clinical trial was performed among healthy volunteers ages 3 months-73 years old. All patients presented for laser treatment of either infantile hemangiomas or PWB with skin types ranging from Fitzpatrick I-V. OCT imaging of 49 hemangioma and PWB scans were performed pre- and post-treatment. The diameter and depth of the blood vessels making up the vascular lesions were measured. In addition, normal skin was scanned for comparison. Five datasets for infantile hemangiomas and five for PWB that were without motion artifacts were analyzed. RESULTS Scanned lesions exhibited variable and highly heterogeneous blood vessel patterns with vessel diameters ranging from 20 to 160 μm, suggesting that the laser treatment with single pulse durations may not be optimal. The largest blood vessel diameter observed (160 μm) may not be adequately treated by commonly used pulsed dye laser pulse durations. CONCLUSION OCT allowed rapid, non-invasive characterization of the diameter and depth of blood vessels in individual vascular lesions. Imaged lesions consisted of a heterogeneous population of vessel sizes, morphologies, and depth. Future studies could utilize this information to assist development of individualized treatment protocols in an effort to improve vascular birthmark removal. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jill S Waibel
- Miami Dermatology and Laser Institute, 7800 S.W 87th Ave Suite B200, Miami, Florida 33173
| | - Jon Holmes
- Michelson Diagnostics Ltd., Eclipse House, Eclipse Park, Sittingbourne Road, Maidstone, Kent, United Kingdom
| | - Ashley Rudnick
- Miami Dermatology and Laser Institute, 7800 S.W 87th Ave Suite B200, Miami, Florida 33173
| | - Daniel Woods
- Michelson Diagnostics Ltd., Eclipse House, Eclipse Park, Sittingbourne Road, Maidstone, Kent, United Kingdom
| | | |
Collapse
|
7
|
Shen L, Zhou G, Zhao J, Li P, Xu Q, Dong Y, Zhang Z. Pulsed dye laser therapy for infantile hemangiomas: a systemic review and meta-analysis. QJM 2015; 108:473-80. [PMID: 25376585 DOI: 10.1093/qjmed/hcu206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Infantile hemangiomas (IH) are common pediatric tumors. This meta-analysis was performed to review the therapeutic efficacy and safety of pulsed dye laser (PDL) in the treatment of IH. METHODS Seven databases were searched, including PubMed, OvidSP, Karger, Elsevier, EMBASE, Web of Science and Wiley Online Library. The review collected the characteristics of year of publication, hemangiomas cases, prior treatment, laser parameters, adverse side, pretreatment symptom, and number of response from all articles. RESULTS A total of 1580 studies were identified, the first round search retrieved 39 articles met inclusion criteria. Of those, only 13 articles with 1529 hemangiomas were included in the meta-analysis. This meta-analysis demonstrated an overall resolution rate of 89.1% with 6.28% incidence of adverse effect. CONCLUSION PDL may be the effective modality to decrease the proliferative phase and accelerate rates of involution and resolution with few adverse events.
Collapse
Affiliation(s)
- L Shen
- From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - G Zhou
- From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - J Zhao
- From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - P Li
- From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Q Xu
- From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Y Dong
- From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Z Zhang
- From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China From the Department of Oral Maxillofacial-Head Neck Oncology, Laser&Cosmetic Center, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China, VIP Department, Stomatology Hospital of Shandong University, Jinan, China and Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
9
|
Kwon SH, Choi JW, Byun SY, Kim BR, Park KC, Youn SW, Huh CH, Na JI. Effect of early long-pulse pulsed dye laser treatment in infantile hemangiomas. Dermatol Surg 2014; 40:405-11. [PMID: 24460784 DOI: 10.1111/dsu.12451] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite several recent reports on the efficacy of long-pulse pulsed dye laser (LP-PDL) in treating infantile hemangiomas, controversy remains. OBJECTIVES To determine the beneficial effects of early therapeutic intervention with LP-PDL in superficial and mixed hemangiomas. METHODS AND MATERIALS Clinical data from 40 children with 47 hemangiomas in preproliferative or proliferative phase treated with LP-PDL in a Korean tertiary hospital over 5 years were analyzed retrospectively. Treatments were repeated at 1- to 4-week intervals until growth stopped. RESULTS Of the 47 hemangiomas, 32 were superficial, and 15 were mixed at presentation. Age was 9.6 ± 5.9 weeks at initiation of treatment and 18.0 ± 8.6 weeks at completion, and a positive linear correlation existed between the two. There were a mean of 4.6 ± 2.6 treatments per hemangioma, which was lower in superficial than in mixed hemangiomas. Improvement in color was documented in 84.4% of superficial and 86.7% of mixed hemangiomas, and 75.0% of superficial and 66.7% of mixed shrank. Hyperpigmentation occurred in two superficial hemangiomas. CONCLUSION Early intervention in hemangiomas using LP-PDL successfully prevents further growth and accelerates a transition to plateau or involution phase with minimal adverse events, achieving good cosmetic outcomes.
Collapse
Affiliation(s)
- Soon Hyo Kwon
- College of Medicine, Seoul National University, Seoul National University Bundang Hospital, Gyeonggi, Korea
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Chen TS, Eichenfield LF, Friedlander SF. Infantile hemangiomas: an update on pathogenesis and therapy. Pediatrics 2013; 131:99-108. [PMID: 23266916 DOI: 10.1542/peds.2012-1128] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Infantile hemangiomas (IHs) are the most common vascular tumors of childhood, affecting ~5% of all infants. Although most lesions proliferate and then involute with minimal consequence, a significant minority can be disfiguring, functionally significant, or, rarely, life-threatening. Recent discoveries concerning hemangioma pathogenesis provide both an improved understanding and more optimal approach to workup and management. Important detrimental associations can be seen with IH, such as significant structural anomalies associated with segmental IH. Standards of care have dramatically changed evaluation and management of hemangiomas. The goal of timely recognition and therapy is to minimize or eliminate long-term sequelae. New modalities, such as oral propranolol, provide the caregiver with better therapeutic options, which can prevent or minimize medical risk or scarring, but the side effect profile and risk-benefit ratio of such interventions must always be evaluated before instituting therapy.
Collapse
Affiliation(s)
- Tina S Chen
- Pediatric Dermatology, Rady Children’s Hospital San Diego, San Diego, California, USA.
| | | | | |
Collapse
|