Laser with dynamic cooling safely clears hemangiomas.

KISSIMMEE, FLA. -- The treatment of childhood hemangiomas using the 595-nm pulsed dye laser with dynamic cooling resulted in excellent clearance rates and relatively few adverse events in 95 infants who had a median age of 4 months, a retrospective chart analysis shows.

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The findings support the recommendation that uncomplicated childhood hemangiomas be treated early to minimize additional growth and hasten the involutional process, Dr. Lori Brightman reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The infants, most of whom were girls with skin types I/II (although all skin types were represented in the study), had not undergone any prior surgery or laser treatment for their hemangiomas. Of a total of 110 superficial and mixed hemangiomas, most were on the head and neck; 52% of the superficial hemangiomas and 65% of the mixed hemangiomas were in the active stage.

The patients were treated between April 2006 and September 2007 at 2- to 8-week intervals until the lesions cleared (an average of 9 months for superficial lesions, and 11 months for mixed lesions).

Treatment was provided using a spot size of 7 mm to 10 mm; an average energy fluence of 8.60J/[cm.sup.2] or 11.48 J/[cm.sup.2], respectively; and a pulse duration of 0.45 or 1.5 milliseconds, with dynamic cooling duration of 30 milliseconds. At a mean of 10 months' follow-up, the treatment resulted in Complete (100%) clearance in 22% of the 67 superficial lesions and 14% of the 43 mixed lesions, and in near-complete (75%-99%) clearance in 60% of the superficial lesions and 68% of the mixed lesions.

Clearance was measured by three independent reviewers based on color and depth of before and after photographs of the lesions, said Dr. Brightman, a dermatologist with a laser and skin surgery group practice in New York. All patients had at least some response, she noted.

Adverse events included hyperpigmentation in 4% and hypopigmentation in 14% of the cases. Ulceration occurred in one case, but was resolved during treatment. There were no cases of atrophy or hypertrophic scarring, she said.

Previous studies of the 585-nm pulsed dye laser for the treatment of childhood hemangiomas used no dynamic cooling, resulting in what was likely an "overrepresentation of adverse outcomes," Dr. Brightman said, noting that the use of updated technology (dynamic cooling, longer wavelengths, and varying pulse widths) appears to provide substantially improved results.

The findings are important, given the early risk of ulceration, infection, and bleeding with childhood hemangiomas, as well as the later risk of obstruction of vital structures, epidermal atrophy, residual telangiectasias, and hyper- and hypopigmentation, she said, noting that the psychosocial component is important to consider as well.

Current approaches to treatment include observation; systemic or intralesional corticosteroids; imiquimod; cryosurgery; sclerotherapy; surgery; and laser treatment, among others.

Dr. Brightman stated she had no conflicts of interest to disclose.

BY SHARON WORCESTER

Southeast Bureau