Laser Treatment of Pigmented and Vascular Lesions in the Office

The treatment of vascular and pigmented lesions has been greatly improved since the introduction of laser technology. Utilizing the principles of selective photothermolysis, physicians can be very specific in their treatment, maximizing injury of the selected target and minimizing damage to surrounding structures. Treatment of vascular lesions is accomplished with a variety of wavelengths. The pulsed-dye laser system remains the gold standard with which all others are compared. A variety of advances in technology in recent years have greatly improved laser treatments. These include the addition of longer pulse widths, variable spot sizes, and a variety of skin-cooling techniques. With today's laser technology, most facial telangiectasias can be treated in a single session with minimal downtime. Angiomas often require more than one treatment. Port wine stains and hemangiomas still require multiple treatments, but treatment sessions are less painful and recovery is quicker. The treatment of pigmented lesions has also improved with new technology. Q-switched systems provide optimal treatment for most pigmented lesions. In general, superficial pigmented lesions are treated with shorter-wavelength systems, and deeper lesions are treated with longer-wavelength systems. The CO₂ laser continues to have a role in difficult-to-treat lesions.

KEYWORDS

Vascular - pigmented - laser - telangiectasia - lentigines

REFERENCES

• 1 Anderson R R, Parrish J A. Selective photothermolysis: precise microsurgery by selective absorption of pulsed irradiation.  Science. 1983;  220 524-527
• 2 Waldorf H A, Lask G P, Geronemus R G. Laser treatment of telangiectasias. In: Alster TS, Apelfberg DB Cosmetic Laser Surgery. New York; Wiley-Liss 1996: 93-109
• 3 Alster T S, Kurban A K, Grove G L et al.. Alteration of argon laser induced scars by the pulsed dye laser.  Lasers Surg Med. 1993;  13 368-373
• 4 Broska P, Martinho E, Goodman M M. Comparison of the argon tunable dye laser with the flashlamp pulsed dye laser in treatment of facial telangiectasia.  J Dermatol Surg Oncol. 1994;  20 749-753
• 5 Dinehart S M, Warner M, Flock S. The copper vapor laser for the treatment of cutaneous vascular and pigmented lesions.  J Dermatol Surg Oncol. 1994;  20 749-753
• 6 West T B, Alster T S. Comparison of the long pulse dye and KTP lasers in the treatment of facial and leg telangiectasias.  Dermatol Surg. 1998;  24 221-226
• 7 Perkins S W, Hamilton M M, Eppley B L, Sadove A M. Evaluation of the Effectiveness of the VersaPulse Laser in the Treatment of Port-Wine Stains. Modesto, CA; Coherent 2000
• 8 Ries W R, Powitzky E S. Lasers in facial plastic surgery. In: Papel I, Nachlas N Facial Plastic and Reconstructive Surgery, 2nd ed. New York; Thieme Medical Publishers 2002: 79-95
• 9 Broska P, Martinho E, Goodman M M. Comparison of the argon tunable dye laser with the flash lamp pulsed dye laser in the treatment of facial telangiectasia.  J Dermatol Surg Oncol. 1994;  20 749-753
• 10 Lowe N J, Behr K L, Fitzpatrick R et al.. Flashlamp pumped dye laser for rosacea associated telangiectasia and erythema.  J Dermatol Surg Oncol. 1991;  17 522-525
• 11 West T B, Alster T S. Comparison of the long-pulse dye (590-595 nm) and KTP (532 nm) in the treatment of facial and leg telangiectasia.  Dermatol Surg. 1998;  24 221-226
• 12 Fitzpatrick R E, Lowe N J, Goldman M P, Borden H, Behr K L, Ruiz-Esparza J. Flashlamp-pumped pulsed dye laser treatment of port wine stains.  J Dermatol Surg Oncol. 1994;  20 743-748
• 13 Garden J M, Bakus A D. Clinical efficacy of the pulsed dye laser in the treatment of vascular lesions.  J Dermatol Surg Oncol. 1993;  19 321-326
• 14 Geronemus R G. Poikiloderma of Civatte.  Arch Dermatol. 1990;  126 547-548
• 15 Gonzalez E, Gange R W, Momtaz K R. Treatment of telangiectasias and other benign vascular lesions with the 577 nm pulsed dye laser.  J Am Acad Dermatol. 1992;  27 220-226
• 16 Hoffman S J, Walsh P, Morelli J G. Treatment of angiofibroma with the pulsed tunable dye laser.  J Am Acad Dermatol. 1993;  29 790-791
• 17 Levine V J, Geronemus R G. Adverse effects associated with 577 and 585 nm pulsed dye laser in the treatment of cutaneous vascular lesions: a study of 500 patients.  J Am Acad Dermatol. 1995;  32 63-67
• 18 Negishi K, Tezuka Y, Kushichca N, Wakamatsu S. Photorejuvenation for Asian skin by intense pulsed light.  Dermatol Surg. 2001;  27 627-631
• 19 Angermeier M C. Treatment of facial vascular lesions with intense pulsed light.  J Cutan Laser Ther. 1999;  1 95-100
• 20 Wheeland R G, Applebaum J. Flashlamp-pumped pulsed dye laser therapy for poikiloderma of Civatte.  J Dermatol Surg Oncol. 1990;  16 12-16
• 21 Ashinoff R, Geronemus R G. Capillary hemangiomas and treatment with the flashlamp pulsed dye laser.  Arch Dermatol. 1991;  127 202-205
• 22 Barlow R J, Walker N PJ, Markey A C. Treatment of proliferative hemangiomas with the 585 nm pulsed dye laser.  Br J Dermatol. 1996;  134 700-702
• 23 Rothfleisch J E, Kosann M K, Levine V J, Ashinoff R. Laser treatment of congenital and acquired vascular lesions.  Dermatol Clin. 2002;  20 (1) 1-15
• 24 Dover J S, Smoller B, Stern R S et al.. Low fluence carbon dioxide laser irradiation of lentigines.  Arch Dermatol. 1988;  124 1219-1224
• 25 Kilmer S L. Laser eradication of pigmented lesions and tattoos.  Dermatol Clin. 2002;  20 (1) 37-51
• 26 Alster T S. Complete elimination of large café-au-lait birthmarks by the 510 nm pulsed dye laser.  Plast Reconstr Surg. 1995;  96 1660-1664