Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology

Abstract

Aim Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions. Results Lasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects. Methods Conflicts of interestNone declared. Funding sourceNone.Since the publication of previous European Society of Laser Dermatology (ESLD) guidelines in 2007, there have been significant advances in the field of laser treatment of common vascular lesions.1 These guidelines have been updated by the Consensus Panel under the auspices of the ESLD. Methodology, search strategy and recommendation formulation are described in Appendix II. A brief overview of vascular lasersStandard vascular lasers include pulsed dye lasers (585 and 595 nm), and KTP-lasers (532 nm), followed by longer wavelength lasers such as alexandrite lasers (755 nm), diode lasers (800-900 nm) and millisecond Nd:YAG lasers (1064 nm). New developments include a non-uniform pulse sequence or a dual-wavelength modality (combined dual wavelength 595 and 1064 nm-pulsed dye and Nd:YAG laser) and microsecond Nd: YAG lasers. [2][3][4][5][6] Even fractional photothermolysis has begun to be used for selected vascular lesions. Lasers' and intense pulse light sources (IPLS) effects are based on the principle of selective photothermolysis. In general, they deliver a precisely graded aliquot of energy to a defined area of the skin in a reproducible, standardized manner that almost always involves addition or evacuation of heat. The greatestThe first two authors have contributed equally to the manuscript.

Retrospective single center study of the efficacy of large spot 532 nm laser for the treatment of facial capillary malformations in 44 patients with the use of three‐dimensional image analysis

“…It was shown previously that objective analysis of the efficacy of treatment of CM gives slightly worse results than subjective methods . Thus, the median maximum improvement obtained in our cohort of previously untreated facial CM reached 70.4% has to be considered as one of the best results available in the literature . Most of the studies conducted on the efficacy of laser treatment for CM included patients with different distribution of skin lesions.…”

Light and lasers for vascular and skin diseases: From bench to clinic – An update

“…This means that different treatment parameters are necessary for different individuals. Laser and photon therapy treatments have been seen to make an effect on vascular dermatoses but as yet have not presented satisfactory results, for example, only 10% of PWS could be completely cured during multiple laser treatments [12] and PDL had no effect on nearly 30% of the lesions.…”

Management of vascular lesions using advanced laser technology

“…Biopsy results showed that vessels in the lateral regions were mainly located in the papillary dermis, whereas in the central regions they tend to expand deeper and run through the dermis into the subcutaneous tissue [44] . In general, however, PWS on the face tend to respond better to the treatment than lesions on the rest of the body [45] . As a whole, the treatment of congenital vascular lesions using laser has been proven to be effective when initiated during the first year of life, something that is partially explained by the fact that the infant's skin is thinner and better penetration of the laser beam within the lesion is achieved [37] .…”