Transcutaneous selective laser photodestruction for the treatment of petechial arachnoid capillary angiodysplasia of the skin in children

Abstract

Introduction. Petechial – arachnoid capillary angiodysplasia (PACA) of the skin is an acquired pathological benign vascular formation that is met in 66% of children aged 4–9. PACA looks like a spider with a vascular red spot in the center and thin vascular rays coming from it. PACA has a benign course; it is slowly and gradually growing over time, and in rare cases it can disappear spontaneously. There have been proposed some techniques for removing PACA: cryodestruction, electrocoagulation, laser coagulation – with CO2-laser light (wavelength 10.6 mkm), copper vapor laser (wavelength 511 and 578 nm), pulsed dye laser (wavelength 585–595 nm). The main disadvantage of cryodestruction, electrocoagulation and laser coagulation with CO2-laser is a high risk of scarring, hyperpigmentation and frequent relapses. While irradiation with copper vapor laser and pulsed dye laser requires repeated exposures to achieve optimal results.Purpose. To improve outcomes in managing children with PACA using a new modality of transcutaneous selective laser photodestruction.Material and methods. For the last two years, 61 children having PACA were treated with transcutaneous selective laser photodestruction in Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (Moscow, Russian Federation ). The researchers used “green” laser light having the following parameters: wavelength 520±10.0 nm, peak power 2.0±0.5 W, pulse duration 1.9 ms, pulse frequency 50 Hz, exposure time 2.0±0.5 sec.Results and discussion. 59 patients had no any residual elements after the first session; the other two had repeated photodestruction because of residual elements. No scar deformity was seen in any of 61 cases after treatment.Conclusion. The present clinical trial has demonstrated that transcutaneous selective laser photodestruction, if to consider spatial localization of PACA structural elements in the skin, allows to precisely irradiate only the central vascular element and to achieve radically good clinical and esthetic outcomes after treatment.