Pediatric capillary malformations respond to pulsed dye laser therapy

October 1, 2010

The pulsed dye laser (PDL) can treat capillary malformations in children and, in exceptional circumstances, infantile hemangiomas, according to a professor of dermatology and pediatrics at the Medical College of Wisconsin, Milwaukee.

Key Points

Milwaukee - The pulsed dye laser (PDL) can treat capillary malformations in children and, in exceptional circumstances, infantile hemangiomas, according to a professor of dermatology and pediatrics at the Medical College of Wisconsin, Milwaukee.

A spider angioma, an abnormal collection of blood vessels that appears as reddish extensions that radiate outwards like the web of a spider, is another presentation that can be treated with lasers in children, Dr. Drolet says.

One of the major considerations in offering laser therapy for pediatric patients is the use of sedation, Dr. Drolet says. The decision to use anesthesia in the pediatric setting depends on the size of the birthmark that a child has, the location of the lesion, the age of the child, the temperament of the child, and the wishes of parents, Dr. Drolet says.

"You have to decide if is something you want to do under general anesthesia or in the office," she says.

Dr. Drolet says a case in which general anesthesia would be applicable would involve a younger child, under age 3, who has a large, facial capillary malformation that may involve the eyelid.

"You would have to use protective eye shields to ensure protection of the eye," Dr. Drolet says. "In my opinion, you would have to sedate such a child."

In terms of making the decision to use general anesthesia, clinicians should look to behavioral clues, such as a child behaving anxiously while in the waiting room prior to the procedure, or not immediately calming down after the procedure, she says. Since exposure to the procedures in some of these pediatric cases may last less than a minute, the use of general anesthesia does not represent a cost-effective option.

Tolerability

Some children tolerate laser therapy very well, while others do not. There are no predictors for how well a child may tolerate laser therapy, according to Dr. Drolet.

"We ask some children how (laser therapy) feels, and some say it doesn't hurt at all, while others say they feel that there is a shock and find it to be quite traumatic," she says. "What children express about how the therapy feels is hugely variable."

Patients may also have a sensation of burning and warmth immediately after laser therapy.

"The laser that we use very rarely scars, because it is designed not to go deep into the skin," Dr. Drolet says. "It is a pretty good modality, but the downside is that it requires so many treatments."

Repeat procedures are typically needed to treat capillary malformations, and the success rate is about 80 percent. "We never get rid of it completely," Dr. Drolet says. She notes an average of six to 20 treatments are required.

Combination therapy

Some clinicians, such as those at the Laser and Skin Surgery Center of New York, are investigating the response to fractional radiofrequency with a device known as eMatrix (Syneron), which received approval from the Food and Drug Administration for cosmetic uses. Investigators are exploring the impact of combination therapy involving fractional radiofrequency treatments and pulsed dye laser treatments to optimize results in some patients.

A study published in Dermatologic Surgery examined the effect of 585 nm pulsed dye laser to treat recalcitrant warts in children. The retrospective analysis found that 75 percent of 61 patients experienced complete clearance of their warts after an average of three treatments. At 24 months follow-up, 75 percent of patients who were included in the study were still free of warts.

Disclosures: Dr. Drolet reports no relevant financial interests.