Laser Therapy:Vascular Lesions

Cutaneous vascular lesions

IPL (intense pulsed light) is now the most popular treatment of vascular lesions.

Rosacea
This includes patient with a combination of skin abnormalities including telangiectasias, papules, pustules, and rhinophyma. The majority of studies have shown an increase in Demodex mites. IPL therapy destroys these mites with heat as well as getting rid of excessive blood vessels associated with this condition. It does so without significant bruising or crusting. In one study of 60 patients treated with IPL, there was an average clearance of 77.8%, maintained for an average of 51.6 months. The entire area affected reddened by rosacea is treated, every 3-4 weeks until clear. Most patients clear in 2-3 treatments. About 20% do not respond and can be treated with a PDL. Most patients return for retreatment every year or two.

Poikiloderma of Civatte

This lesion is characterized by widespread telangiectasias and hyperpigmented lesions often on the neck and all across the chest. IPL targets both abnormal blood vessels as well as melanin. Two or three treatments are usually necessary four weeks apart. With conservative laser parameters, few side effects are seen and a 50-78% improvement noted. Associated improvement in skin texture was seen. Side effects occur in 5%. They include transient redness for 24-72 hours and bruising in 10%. Bruising resolves in 3-5 days. A minimal stinging is noted. No anesthesia is used and the whole neck and chest can be treated in one session.

Verruca Vulgaris

These are warts, benign tumors caused by the human papilloma virus. They occur in 10% of adults and children. These growths contain enlarged blood vessels. Laser therapy vaporizes and clots off the new blood vessels to stop viral spread and resolves the warts. Lasers used include the PDL and the Nd:YAG laser. With the later, 31 patients were treated 3 times every 3 weeks. 77% of patients cleared completely without scarring and with no recurrences.
Using IPL, the wart is exposed through a hole punched into a white card. The IPL head is placed on the wart and radiated. The IPL beam does not penetrate the white card. One to three pulses are given until the wart turns grey. There is no pain involved.