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Haemangiomas
What Is the Place of Vascular Lasers in the Early Treatment of Haemangiomas?
Jean-Michel Mazer
Medical Director, Centre Laser Trevise and Centre Laser International de la Peau de Paris
Abstract
The early treatment of haemangiomas is very controversial for several reasons. The results of different studies do not offer the same
conclusions. Some tend to treat very early, but others conclude that early treatment with pulsed dye lasers (PDLs) is not effective in terms
of preventing sequelae after regression. However, a study by Batta et al. made patient evaluations at one year of age. One can consider
that a good question to ask is: does early laser treatment reduce the rate and severity of the sequelae that we are used to seeing on 10-
year-old children? To determine the risk–benefit ratio of laser treatment, we would need to perform a study comparing the ‘wait and see
policy’ with laser treatment with a 10-year follow-up period, but this is very difficult. Another key point is to determine the best
parameters (short or long pulse durations, fluence) for PDLs. It is also very important to remember that this type of laser is much more
effective on flat, telangiectatic lesions, not on thick and deep components. This means that if we decide to treat, treatment must be
applied during the first few weeks without knowing the future severity of the haemangioma. This explains the difficulty involved in making
the best decision for the patient.
Keywords
Haemangiomas, lasers, pulsed dye lasers
Disclosure: The author has no conflicts of interest to declare.
Received: 5 March 2009 Accepted: 21 April 2009
jmmazer@wanadoo.fr
Haemangioma is a very common lesion, but its severity is variable, as it not logical and reasonable to consider that treating flat, telangiectatic
is often moderate and sometimes severe. Therefore, it is necessary to lesions during the first month of life is the same treatment with regard
discuss treatment. To determine the severity of a haemangioma, the to the risk–benefit ratio as treating a two- to six-month-old child with a
main criteria are the topography of the face and the size and thickness. thick lesion and a deep component.
Another criterion is the thickness: the thicker the lesions are, the
greater the consequences in terms of atrophy and chalazodermia. At the same time, we cannot forget that it is not actually possible to
determine the evolution that a flat lesion will take. Some will stay
Several treatments are available,
1,2
but the role of vascular lasers has telangiectatic and will present a complete regression a few years later,
been discussed and is controversial. Some physicians believe that while others will become deep and thick and will probably recur
there is no place in the therapeutic armamentarium for laser therapy. (sometimes moderately but sometimes very severely: atrophy, laxity,
However, another trend is to treat very early, during the first few cholazodermia). In order to determine the role of the vascular lasers, we
weeks, to stop further progression of the lesion. In order to determine must answer the following questions:
the best strategy, we have to determine the risk–benefit ratio of
treatment and compare it with the other therapeutic choices and the • which vascular laser?
‘wait and see’ strategy. • what is the effectiveness?
• what are the risks of the laser therapy?
Considering childhood haemangiomas, we also have to ask ‘at which • what are the risks of the wait and see policy?
stage do we have to use lasers?’: • what are the other therapeutic options? and
• what is the risk–benefit ratio?
• do we have to treat very early, as a preventative treatment, to
avoid recurrence; or Which Vascular Laser? What Efficacy?
• do we have to treat only when we are sure that the risks of side What Risks?
effects (in particular atrophy) are high because the lesion has Many lasers have been proposed to treat haemangiomas: potassium
become thick? titanyl phosphate (KTP) lasers;
3
pulsed dye lasers (PDL) with short
(0.45–6 milliseconds) or long (6–20 milliseconds) pulse duration;
4–8
This is a key point because the two strategies are different and, in my neodymium-doped:yttrium–aluminium–garnet (Nd:YAG) lasers; and
mind, this partially explains the fact that this topic is hotly debated. It is intense pulsed light (IPL) lasers. Nevertheless, most of the studies are
© TOUCH BRIEFINGS 2009 73
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