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Pyogenic granuloma appearing in a port wine stain after pulsed dye laser treatment
3382
3179 Pyogenic granuloma appearing in a port wine stain after pulsed dye laser treatment Jason Meeker, MD, West Virginia University, Morgantown, WV, United States; Marcus Bruce, West Virginia University, Morgantown, WV, United States; Roxann Powers, MD, West Virginia University, Morgantown, WV, United States Pyogenic granulomas are a known complication of port wine stains and other vascular malformations. Reports include induction of the pyogenic granuloma within the port wine stain spontaneously, after trauma, or after treatment with pulsed dye lasers or cryotherapy. The very treatments used in an attempt to treat port wine stains, can lead to trauma resulting in formation of pyogenic granulomas. The simultaneous occurrence of port wine stain and pyogenic granuloma is likely underreported, as well as the relationship to trauma from laser therapy. We present a 53-year-old female with persistent port wine stain following pulsed dye laser treatment over a 10 year period. She was being treated every other month with gradual improvement when a new, vascular appearing, purple, nodular lesion appeared rapidly one month after one of her laser treatments. Biopsy was performed and it was shown to be a pyogenic granuloma. It remains interesting that the very treatments we use frequently for port wine stains can trigger formation of new lesions, such as port wine stains, that can also be paradoxically treated with laser modalities. Development of pyogenic granulomas in port wine stains can occur as a natural progression of the malformation, but our attempts at treatment may actually trigger this rare complication of vascular malformations. Commercial support: None identified.
3902
3078 Prospective comparison of the dual wavelength long-pulsed 755-nm alexandrite/1064-nm neodymium:YAG laser versus 585-nm pulsed dye laser treatment for rosacea Han-Saem Kim, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Young-Joon Choi, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Ho Joo Jung, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Jae Hui Nam, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Ga-Young Lee, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Won-Serk Kim, MD, PhD, Kangbuk Samsung Hospital, Seoul, South Korea Background: Rosacea is a common cutaneous disorder presenting with erythema, flushing, telangiectasia, papules and pustules, but current treatments include oral/topical agent and vascular laser therapy are not satisfactory. Objective: To compare the effectiveness of the dual wavelength long-pulsed 755-nm alexandrite/1064-nm Nd:YAG laser (LPAN) with 585-nm pulsed dye laser (PDL) for rosacea. Methods: This was a single-blind randomized controlled trial. Full face received 4 consecutive monthly treatments with LPAN or PDL, and followed up to 6-month postcompletion of the treatment protocol. Clinical outcomes were evaluated by spectrophotometry, digital photographs, and patient satisfaction surveys. Results: Thirty rosacea patients, all skin types III to V, 57% women, mean age 49 years, completed the study and were analyzed. There was no significant difference between LPAN and PDL in the mean reduction of the erythema values by spectrophotometry (P ¼ .517; 3.l% vs 2.8%) and erythema improvement by photographic assessment (P ¼ .325; 83.3% vs 78.6%), respectively. However, patients with more than 50% improvement by photographic assessment was higher in LPAN than that in PDL (P ¼ .025; 14.3% vs 8.3%).
Reducing anxiety levels in parents of children undergoing general anesthesia for laser treatment of vascular and pigmented birthmarks Woraphong Manuskiatti, MD, Siriraj Skin Laser Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Chanida Ungaksornpairote, MD, Siriraj Skin Laser Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Angkana Sathaworawong, MD, Siriraj Skin Laser Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Pichaya Waitayawinyu, MD, Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Rungsima Wanitphakdeedecha, MD, Siriraj Skin Laser Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Background: Laser therapy has become widely accepted as the treatment of choice for a variety of vascular and pigmented birthmarks. Laser treatment cannot be safely and properly performed in infants and children using local anesthesia alone. The use of general anesthesia (GA) in children certainly causes anxiety to their parents. Objective: To determine whether viewing a preoperative CD video helped parents of children scheduled for laser treatment under GA feel less anxious. Methods: An eight-minute CD video was produced. A number of issues of common concerns were addressed including general information about pediatric anesthesia, preoperative preparation, induction techniques, potential of anesthetic complications and the interviews of the parents whose children underwent laser treatments under GA. During a clinic visit, 1 to 2 months before an electively scheduled outpatient procedure, each parent was assessed his or her anxiety level using Amsterdam Preoperative Anxiety and Inventory Scale (APAIS) at immediately before and after watching the video.
Limitations: Laser settings are not standardized between two devices. Conclusions: Both LPAN and PDL are effective in the treatment for rosacea. Compared with PDL, LPAN may be more effective in rosacea treatment.
Results: There were 6 (30%) boys and 14 (70%) girls, with a median age of 1.4 (min ¼ 0.2, max ¼ 10) years old who underwent laser treatment of their birthmarks. Laser procedures were performed for port wine stain in 11 (55%) children, nevus of Ota in 6 (30%), superficial hemangiomas in 1 (5%), lymphangioma in 1 (5%) and phacomatosis pigmentovascularis in 1 (5%). Thirty-three parents of twenty children completed the questionnaire with the baseline of high anxiety to the administration of general anesthesia and laser procedures (APAIS ¼ 23). A significant reduction in APAIS (from 23 to 16, P\.001) was noted after watching the video. The worry about the GA (P \.001) and laser treatment (P \.001) significantly reduced after viewing the video. Conclusions: Watching a preoperative CD video providing essential information on pediatric anesthesia can significantly reduce level of anxiety in parents of children undergoing laser treatment under GA.
Commercial support: None identified.
Commercial support: None identified.
AB290
J AM ACAD DERMATOL
MAY 2016
3179 Pyogenic granuloma appearing in a port wine stain after pulsed dye laser treatment Jason Meeker, MD, West Virginia University, Morgantown, WV, United States; Marcus Bruce, West Virginia University, Morgantown, WV, United States; Roxann Powers, MD, West Virginia University, Morgantown, WV, United States Pyogenic granulomas are a known complication of port wine stains and other vascular malformations. Reports include induction of the pyogenic granuloma within the port wine stain spontaneously, after trauma, or after treatment with pulsed dye lasers or cryotherapy. The very treatments used in an attempt to treat port wine stains, can lead to trauma resulting in formation of pyogenic granulomas. The simultaneous occurrence of port wine stain and pyogenic granuloma is likely underreported, as well as the relationship to trauma from laser therapy. We present a 53-year-old female with persistent port wine stain following pulsed dye laser treatment over a 10 year period. She was being treated every other month with gradual improvement when a new, vascular appearing, purple, nodular lesion appeared rapidly one month after one of her laser treatments. Biopsy was performed and it was shown to be a pyogenic granuloma. It remains interesting that the very treatments we use frequently for port wine stains can trigger formation of new lesions, such as port wine stains, that can also be paradoxically treated with laser modalities. Development of pyogenic granulomas in port wine stains can occur as a natural progression of the malformation, but our attempts at treatment may actually trigger this rare complication of vascular malformations. Commercial support: None identified.
3902
3078 Prospective comparison of the dual wavelength long-pulsed 755-nm alexandrite/1064-nm neodymium:YAG laser versus 585-nm pulsed dye laser treatment for rosacea Han-Saem Kim, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Young-Joon Choi, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Ho Joo Jung, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Jae Hui Nam, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Ga-Young Lee, MD, Kangbuk Samsung Hospital, Seoul, South Korea; Won-Serk Kim, MD, PhD, Kangbuk Samsung Hospital, Seoul, South Korea Background: Rosacea is a common cutaneous disorder presenting with erythema, flushing, telangiectasia, papules and pustules, but current treatments include oral/topical agent and vascular laser therapy are not satisfactory. Objective: To compare the effectiveness of the dual wavelength long-pulsed 755-nm alexandrite/1064-nm Nd:YAG laser (LPAN) with 585-nm pulsed dye laser (PDL) for rosacea. Methods: This was a single-blind randomized controlled trial. Full face received 4 consecutive monthly treatments with LPAN or PDL, and followed up to 6-month postcompletion of the treatment protocol. Clinical outcomes were evaluated by spectrophotometry, digital photographs, and patient satisfaction surveys. Results: Thirty rosacea patients, all skin types III to V, 57% women, mean age 49 years, completed the study and were analyzed. There was no significant difference between LPAN and PDL in the mean reduction of the erythema values by spectrophotometry (P ¼ .517; 3.l% vs 2.8%) and erythema improvement by photographic assessment (P ¼ .325; 83.3% vs 78.6%), respectively. However, patients with more than 50% improvement by photographic assessment was higher in LPAN than that in PDL (P ¼ .025; 14.3% vs 8.3%).
Reducing anxiety levels in parents of children undergoing general anesthesia for laser treatment of vascular and pigmented birthmarks Woraphong Manuskiatti, MD, Siriraj Skin Laser Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Chanida Ungaksornpairote, MD, Siriraj Skin Laser Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Angkana Sathaworawong, MD, Siriraj Skin Laser Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Pichaya Waitayawinyu, MD, Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Rungsima Wanitphakdeedecha, MD, Siriraj Skin Laser Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Background: Laser therapy has become widely accepted as the treatment of choice for a variety of vascular and pigmented birthmarks. Laser treatment cannot be safely and properly performed in infants and children using local anesthesia alone. The use of general anesthesia (GA) in children certainly causes anxiety to their parents. Objective: To determine whether viewing a preoperative CD video helped parents of children scheduled for laser treatment under GA feel less anxious. Methods: An eight-minute CD video was produced. A number of issues of common concerns were addressed including general information about pediatric anesthesia, preoperative preparation, induction techniques, potential of anesthetic complications and the interviews of the parents whose children underwent laser treatments under GA. During a clinic visit, 1 to 2 months before an electively scheduled outpatient procedure, each parent was assessed his or her anxiety level using Amsterdam Preoperative Anxiety and Inventory Scale (APAIS) at immediately before and after watching the video.
Limitations: Laser settings are not standardized between two devices. Conclusions: Both LPAN and PDL are effective in the treatment for rosacea. Compared with PDL, LPAN may be more effective in rosacea treatment.
Results: There were 6 (30%) boys and 14 (70%) girls, with a median age of 1.4 (min ¼ 0.2, max ¼ 10) years old who underwent laser treatment of their birthmarks. Laser procedures were performed for port wine stain in 11 (55%) children, nevus of Ota in 6 (30%), superficial hemangiomas in 1 (5%), lymphangioma in 1 (5%) and phacomatosis pigmentovascularis in 1 (5%). Thirty-three parents of twenty children completed the questionnaire with the baseline of high anxiety to the administration of general anesthesia and laser procedures (APAIS ¼ 23). A significant reduction in APAIS (from 23 to 16, P\.001) was noted after watching the video. The worry about the GA (P \.001) and laser treatment (P \.001) significantly reduced after viewing the video. Conclusions: Watching a preoperative CD video providing essential information on pediatric anesthesia can significantly reduce level of anxiety in parents of children undergoing laser treatment under GA.
Commercial support: None identified.
Commercial support: None identified.
AB290
J AM ACAD DERMATOL
MAY 2016