Comparison study of a traditional pulsed dye laser versus a long‐pulsed dye laser in the treatment of early childhood hemangiomas

Abstract

Background and Objective: The role of pulsed dye laser (PDL) in the treatment of childhood hemangiomas is still controversial because of the inherent characteristics of hemangiomas as well as the side effects of the PDL. Recently, the long pulsed dye laser (LPDL) with cryogen spray cooling (CSC) has been found relatively more effective and safer than the PDL in the treatment of portwine stains and telangiectasia. This study was designed to compare the efficacy and complication rate of PDL versus LPDL for treating childhood hemangiomas. Study Design/Materials and Methods: We did a prospective, randomized, controlled trial in which we enrolled 52 Asian infants, aged 1-3 months, with early hemangiomas. These infants were assigned to PDL treatment (n ¼ 26) or LPDL treatment (n ¼ 26) and followed to age 1 year. A PDL with a wavelength of 585 nm and spot size of 7 mm and a LPDL with a wavelength of 595 nm and spot size of 7 mm were used. Each patient in the PDL group was treated with energy fluence between 6 and 7 J/cm 2 and a pulse duration of 0.45 milliseconds without epidermal cooling. Each patient in the LPDL group was treated with energy fluence between 9 and 15 J/cm 2 and a pulse duration of 10-20 milliseconds, utilizing CSC to protect the epidermis. Each group was treated at 4-week intervals until the lesion cleared. When each patient reached an age of 1 year, outcome measures such as clearance rate, time period of maximum proliferation, and complications were assessed. Results: The number of children whose lesions showed complete clearance or minimal residual signs at 1 year of age was 14 (54%) in the PDL group and 17 (65%) in the LPDL group (P ¼ 0.397). Compared with the LPDL, PDL treated children had more hypopigmentation (3, 12% vs. 8, 31%; P ¼ 0.001), more hyperpigmentation (2, 8% vs. 4, 15%; P ¼ 0.005), and more textural changes (1, 4% vs. 6, 23%; P ¼ 0.001). The average time period of maximum proliferation in the LPDL group was significantly shorter than that of the PDL group (106 days vs. 177 days; P ¼ 0.01). Conclusion: Early treatment of childhood hemangiomas with the LPDL is safer and more effective than the PDL.

Cyclin D1 gene amplification in proliferating haemangioma

“…Several hypotheses have been proposed concerning the process of haemangiogenesis, including the possible role of somatic mutation in one or more components of critical vascular growth-regulatory pathways (Walter et al 2002). The high endothelial cell proliferation and turnover and the high mitotic activity during the proliferation of haemangiomas suggest that these lesions should be considered as tumours (Ethunandan and Mellor 2006;Kono et al 2006).…”

Management of vascular lesions using advanced laser technology

“…Although this difference was not statistically significant, the group treated with PDL had significantly more hypopigmentation (3.12% vs. 8.31%; p = 0.001), more hyperpigmentation (2.8% vs. 4.15%; p = 0.005), and more textural changes (1.4% vs. 6.23%; p = 0.001). Finally, the average time period of maximum proliferation in the LPDL group was significantly shorter [23] . Recently, a comparison study was carried out in order to identify the earlier regression, the prevention of further proliferation, and the achievement of a better cosmetic outcome using PDL treatment in comparison to observation only (-wait-and-see approach‖).…”

Evidence-Based Medicine in the Treatment of Infantile Hemangiomas

“…75 The PDL has been used and studied for more than 30 years as an option for treatment of IHs, and, as a result, there is substantial level III-V evidence in the form of various case reports, retrospective reviews, and small, nonrandomized prospective studies supporting its efficacy in the literature. [76][77][78][79][80][81][82][83] In 2002, the first level III evidence comparing PDL therapy to observation in the treatment of IHs was performed by Batta and colleagues 84 and raised significant doubt surrounding its efficacy. The investigators' analysis revealed no benefit in the number of children whose lesions showed complete clearance or minimal residual signs at 1 year in the PDL versus observation group.…”