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What Is the Place of Vascular Lasers in the Early Treatment of Haemangiomas?
lesion. After regression, the superficial component tends to lead to Except for lasers, the only treatment that presents an interesting
telangiectasias, which are easy to treat later, but also to atrophy, risk–benefit ratio is therapy with beta-blockers. A key point to
chalazodermia and achromia. improve tolerability is to choose the best parameters and to use a
cooling device to protect the epidermis. Considering the
There is a lack of data regarding the rate of sequelae after regression, parameters, further studies are necessary to determine which are
but some are severe and justify surgery and difficult laser therapy. the best pulse durations: short or long?
We must not forget that having a haemangioma on the face is
difficult for the child when he or she has to go to school, for example. The question is to determine the place of the wait and see policy,
The risks of this policy are inducing psychological side effects and treatment with PSLs with cooling devices or beta-blockers. For
allowing sequelae. severe haemangiomas, the choice must be made between beta
blockers and/or laser therapy and maybe, eventually, surgery. For
Which Other Treatments? moderate or benign lesions, the choices are the wait and see policy
There are other treatments for haemangioma, including or PSLs. However, to be logical we have to decide very early, when
corticosteroids, interferon-α and surgery, but they present many side the lesions are flat. If we wait, PDL therapy will be less effective,
8
and
effects. In cases of severe haemangioma, we have to use these that is the paradox: we have to treat lesions without knowing their
treatments. A new therapeutic option is very interesting, and could future and thus without knowing whether the treatment is necessary.
change our strategy. Leauté-Labreze et al.
14,15
showed that it was
possible with beta-blockers 2–4mg/kg/day to improve severe Conclusion
haemangioma dramatically and very quickly (in one to two days) and The question of the place of the laser as an early treatment is still
to inhibit further progression. The tolerability profile of beta-blockers highly debatable. The answer will differ depending on the age of the
is well-known and good. It is reasonable to think that this treatment child, the type (mainly thickness) of the lesion, the choice of laser, the
will probably become the treatment of choice for severe parameters and the use of a cooling device. This probably explains
haemangiomas. However, that raises the question: ‘What about the why the conclusions of the studies mentioned above are so variable.
majority of haemangiomas, which are not very severe?’
In fact, to answer this question, we would need to undertake a
Discussion comparative study where one half of the lesion is treated and the
The laser treatment of haemangiomas is still debatable for several other half acts as the control area. We would see the differences in
reasons. It is very difficult to draw comparative studies with a good terms of sequelae 10 years later. The problem is that, for ethical
methodology and long-term follow-up in newborns. The results can be reasons, it is very difficult to carry out this type of study, and so this
vary widely depending on the choice of laser, their settings, the use of topic will probably remain controversial. ■
a cooling device and the timing of the first treatment.
11,12
The type of
lesions (telangiectatic, red-flat, deep) will be very important.
Jean-Michel Mazer is Medical Director of the Centre
According to the studies and our experience, it seems clear that the
Laser Trevise and the Centre Laser International de la
best results are observed when we can treat telangiectatic or very flat Peau de Paris. He specialises in laser therapies and
lesions very early (within the first weeks). There is, of course, a
his research interests are treating port wine stains,
haemangiomas and radiodermatitis. He is a founder
relationship between the type of lesion, its depth and thickness and
member and former Vice President of the Laser
the age of the child. Group of the French Society of Dermatology, a
member of the American Society for Laser Medicine
and Surgery (ASLMS) and a member of the European
The practical reality is that we have to treat without knowing
Society for Laser Dermatology (ESLD). He has received two awards from the
whether the haemangioma will become very thick or remain flat and French Society of Dermatology for the treatment of radiodermatitis by PDL, and one
benign. If we wait for longer and decide to treat only in cases of
in the field of paediatric dermatology in 2000 for the tolerability of high fluences
with PDL in newborns.
thick lesions, we will probably be not very effective due to the slight
penetration of PDL.
1. Frieden IJ, Eichenfield LF, Esterly NB, et al., American the effectiveness of 585nm versus 595nm wavelength childhood hemangioma with the flashlamp-pumped
Academy of Dermatology Guidelines/Outcomes pulsed dye laser treatment of port wine stains in pulsed dye laser: an evaluation of 617 cases, Lasers Surg
Committee, Guidelines of care for hemangiomas of conjunction with cryogen spray cooling, Lasers Surg Med, Med, 2001;28(3):273–7.
infancy, J Am Acad Dermatol, 1997;37(4):631–7. 2002;31(5):352–8. 12. Ashinoff R, Geronemus RG, Failure of the
2. Grantzow R, Schmittenbecher P, Cremer H, et al., 7. Witman PM, Wagner AM, et al., Complications following flashlamp-pumped pulsed dye laser to prevent
Hemangiomas in infancy and childhood. S 2k Guideline of pulsed dye laser treatment of superficial hemangiomas, progression to deep hemangioma, Pediatr Dermatol,
the German Society of Dermatology with the working Lasers Surg Med, 2006;38(2):116–23. 1993;10(1):77–80.
group Pediatric Dermatology together with the German 8. Poetke M, Philipp C, Berlien HP, Flashlamp-pumped pulsed 13. Shafirstein G, Buckmiller LM, Waner M, Bäumler W,
Society for Pediatric Surgery and the German Society for dye laser for hemangiomas in infancy: treatment of Mathematical modeling of selective photothermolysis to
Pediatric Medicine, J Dtsch Dermatol Ges, 2008;6(4):324–9. superficial versus mixed hemangiomas, Arch Dermatol, aid the treatment of vascular malformations and
3. Clark C, Cameron H, Moseley H, et al., Treatment of 2000;136(5):628–32. hemangioma with pulsed dye laser, Lasers Med Sci,
superficial cutaneous vascular lesions: experience with 9. Batta K, Goodyear HM, Moss C, et al., Randomised 2007;22(2):111–18.
the KTP 532 nm laser, Lasers Med Sci, 2004;19(1):1–5. controlled study of early pulsed dye laser treatment of 14. Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, et al.,
4. Kono T, Sakurai H, Groff WF, et al., Comparison study of a uncomplicated childhood haemangiomas: results of a Propranolol for severe hemangiomas of infancy, N Engl J
traditional pulsed dye laser versus a long-pulsed dye laser one-year analysis, Lancet, 2002;360(9332):521–7. Med, 2008;358(24):2649–51.
in the treatment of early childhood hemangiomas, Lasers 10. Chang CJ, Kelly KM, Nelson JS, Cryogen spray cooling and 15. Léauté-Labrèze C, Taïeb A, Efficacy of beta-blockers in
Surg Med, 2006;38(2):112–15. pulsed dye laser treatment of cutaneous hemangiomas, infantile capillary haemangiomas: the physiopathological
5. Michel JL, Treatment of hemangiomas with 595nm pulsed Ann Plast Surg, 2001;46(6):577–83. significance and therapeutic consequences, Ann Dermatol
dye laser dermobeam, Eur J Dermatol, 2003;13(2):136–41. 11. Hohenleutner S, Badur-Ganter E, Landthaler M, Venereol, 2008;135(12):860–62.
6. Chang CJ, Kelly KM, Van Gemert MJ, Nelson JS, Comparing Hohenleutner U, Long-term results in the treatment of
EUROPEAN DERMATOLOGY 75
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