Harrison Hot Springs, British Columbia ? There have been many advances in laser technology for medical applications, but for the treatment of pediatric skin diseases, dermatologists are still turning to the "tried-and-true" pulsed dye, Q-switched pigment and CO2 lasers.
In his "Lasers for Pediatric Skin Disease" seminar at the recent Pacific Northwest Dermatological Conference here, Ken K. Lee, M.D., discussed how these laser technologies are best applied in the treatment of various pediatric skin diseases - and why they're still preferred even as new technologies are hitting the market.
Dr. Lee, director of dermatologic and laser surgery at the Oregon Health & Science University, Portland, Ore., focuses on laser treatment of several common pediatric skin disorders: port wine stains (PWS), hemangiomas, pyogenic granulomas, scars, pigmented lesions (nevus of Ota, congenital nevi) and epidermal nevi.
According to Dr. Lee, pulse dye laser is still the treatment of choice for most port wine stains.
"The results are best when treatment is started early, when the vessels are relatively small and the PWS is not thickened," he says. "Multiple treatment sessions are needed to fade a PWS and only a small percentage disappear completely. Other lasers, such as the long-pulsed 1064 nm YAG lasers, can be used for PWS but usually are helpful for thicker lesions. Intense pulsed light also has been reported to have modest success in PWS."
Dr. Lee says that moderate to large PWS in young children are best treated under general anesthesia. As for new concepts, he says photodynamic therapy is used successfully in China for refractory PWS.
"New imaging techniques are being developed to better assess PWS in order to better tailor the laser therapy," says Dr. Lee, who currently has a National Institutes of Health grant to study noninvasive imaging of skin diseases.
Lasers are generally not the first-line treatment for hemangiomas, Dr. Lee tells Dermatology Times. Used less frequently than in the past, lasers can promote scarring, according to some studies, he says.
"Systemic, intralesional and topical steroids should be used first, but there are situations where lasers are helpful," Dr. Lee explains. "Thin, early hemangiomas sometimes respond very nicely to several sessions with the pulse dye laser, and residual superficial components after regression also respond well to laser treatment. If the hemangioma is ulcerated or bleeding, treatment with the pulse dye laser is also indicated."
Refractory pyogenic granulomas can be treated with any vascular laser. Dr. Lee says that it's helpful to compress the lesion with a glass slide and shoot the laser through it.
"This effectively brings the deeper vessels closer to the surface," he says.
Hypertrophic scars respond well to pulsed dye laser treatment, according to Dr. Lee.
"The laser should be set at a subpurpuric level, and the scar should be treated a few times," he says. "Intralesional steroid is used immediately after the laser. Due to the edema caused by the laser, the steroid injects much more smoothly and is more effective."
Various congenital and acquired pigmented lesions can be treated with the laser. Generally, Dr. Lee says, the Q-switched pigment lasers are the most effective.
Nevus of Ota
Patients can expect to need more than 10 treatments for this skin disease, Dr. Lee says.
"It is helpful to have multiple different Q-switched lasers for the best results - I use the Q-switched ruby, alexandrite, 532 nm YAG and 1064 nm YAG lasers when treating a nevus of Ota," he says.