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LASER THERAPY FOR VASCULAR LESIONS

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SUMMARY

  • Laser therapy for vascular lesions targets oxyhemoglobin as the chromophore, with absorption peaks at 418, 542, and 577 nm.

  • Blood vessel depth, thickness, and skin type are factors that are often considered for each patient.

image Beginner Pearls

  • Several types of lasers are available for the treatment of vascular lesions, including the pulsed dye laser (PDL); potassium titanyl phosphate (KTP) laser; neodymium:yttrium aluminum garnet (Nd:YAG) laser; CO2 laser; argon laser; copper vapor laser; and intense pulsed light (IPL).

  • PDL is currently the treatment of choice for PWS due to the low risk of scarring and acceptable complication rates, despite a relatively modest degree of total clearance, at approximately 15% to 20%.

image Expert Pearls

  • Rosacea and diffuse erythema have been successfully treated with PDL, IPL, and long-pulsed Nd:Yag (532 nm) lasers.

  • A combination of lasers, phlebectomy and sclerotherapy may be the best long-term approach for treating leg veins, though as a monotherapy, sclerotherapy remains the gold standard treatment for leg veins.

image Don’t Forget!

  • Purpuric settings consist of a single pass with shorter pulse durations (0.45, 1.5 ms) and higher fluences.

  • Nonpurpuric settings require multiple passes with longer pulse durations (6 ms) and lower fluences.

image Pitfalls and Cautions

  • Given the widespread use and high success rates with using topical and oral beta blockers, laser treatment for HOI is becoming less common.

  • When KTP lasers are used for leg veins, hyper- and hypopigmentation have been reported to occur in 20% to 40% of patients.

  • Caution must be taken with multiple passes, which can result in vessel rupture with subsequent hemosiderin deposition with long-pulsed Nd:Yag lasers.

image Patient Education Points

  • Patients should understand the risks of laser treatment, including dyspigmentation.

  • It is important that patients understand that most laser treatments involve multiple visits.

imageBilling Pearls

  • Almost all insurers in the United States exclude laser treatments from coverage.

  • Patients may benefit from committing to a series of treatments, as this may allow significant cost savings.

  • Pre-treatment with occluded topical anesthesia can be started at home, and prescription plans may cover the cost of this medication.

INTRODUCTION

Laser therapy for vascular lesions targets oxyhemoglobin as the chromophore, with absorption peaks at 418, 542, and 577 nm. One of the main goals in laser therapy is to focus the laser on its desired target with minimal effect on normal skin, including melanocytes and hair follicles.1 Blood vessel depth, thickness, and skin type are factors that are often considered for each patient.

Types of lasers available for the treatment of vascular lesions

Several types of lasers are available for the treatment of vascular lesions, including the pulsed-dye laser (PDL); potassium titanyl phosphate (KTP) laser; neodymium:yttrium aluminum garnet (Nd:YAG) laser; CO2 laser; argon laser; copper vapor laser; and ...

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