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S021 What age should treatment for vascular naevi be started? Are we treating the patient or the parent?
Symposia
-
Controversies
Controversies in Del;matological Lasers 1SO18 1 Controversies in dermatological G.E. Allen. City Hospital,
Belfast,
lasers
N Ireland
The use of lasers in dermatological conditions is a rapidly developing and expanding field. Much progress has been made in treating some conditions such as vascular naevi, but many unanswered questions remain, and there are still differing views about which lesions we should be treating. There is also much that we do not fully understand about laser/tissue interaction. This symposium will attempt to address some of the areas of uncertainty, and look at some of the more recent applications for laser treatments in dermatology.
ISO19
Strawberry nevi - To treat or not to treat?
M. Landthaler, U. Hohenleutner. Dept. ofDermatology, University
of Regensburg,
Germany
App. 5% of new-borns suffer from childhood haemangiomas (strawberry nevi). Despite their spontaneous regression, many reports were published in the last decade about the therapy of these benign vascular tumours, either with the flash lamppumped pulsed dye laser (FPDL) or - more rarely- by various Nd:YAG-laser techniques. Additionally, systemic therapy with corticosteroids and IF-o proved to be effective in some patients. Arguments in favour of active therapy are: excellent results in early flat lesions, easy-to-perform therapy, rare side effects of FPDL-therapy, complications of haemangiomas (ulceration, bleeding, involvement of important structures, rapid growth, psychological distress, residual lesions after spontaneous regression), development of haemangiomas is not predictable, extensive lesions may develop from very small and superficial ones and, finally, 60% of lesions do not regress until the age of six. Arguments against therapy are: spontaneous regression in nearly 100% of patients, children of this age are not concerned by their haemangiomas, therapy is painful and does harm to the children, complications of laser therapy, development of deep haemangiomas can not be prevented in all cases and Nd:YAG laser therapy can only be performed in general anaesthesia. Literature of the last ten years as well as our own experience with more than 400 children show that - in our opinion - all initial haemangiomas should be treated. More advanced lesions could be treated if complications do occur or if important structures are involved.
SO20 El
Why do some port wine stains not respond to the pulsed dye laser?
Sean W. Lanigan. Bridgend Wales,
General
Hospital,
Bridgend,
in Dermatological
s9
Lasers
l-10 ms for thermal coagulation of PWS vessels. The 450 micros PDL pulse duration will be too short to coagulate all PWS vessels. Also deeply sited lesions will receive an inadequate light dose. Histological studies of unresponsive PWS have shown ectatic dermal blood vessels empty of red blood cells; the target of this laser. Recent non-invasive studies using a videomicroscopy to assess vascular patterns of PWS have identified patterns of ectasia with good and poor outcomes from treatment which may more accurately predict response to therapy in the future. The results of these investigations in addition to clinical and theoretical observations will be discussed in this presentation.
ISO21
What age should treatment for vascular naevi be started? Are we treating the patient or the parent?
Neil P.J. Walker. FRCR
Churchill
Hospital,
Oxford,
In considering the treatment of vascular naevi a number of factors have to be taken into account. It is of paramount importance to make an accurate diagnosis and on this basis give a prognosis. It is sometimes difficult to be precise but patients and their families are happier when the nature of a naevus and the likely natural course have been explained. In many cases when a lesion is symptomatic, such as a painful angiokeratoma or ulcerated capillary angioma then the indications for treatment are clear and therapy can be instigated as soon as practical. As regards capillary malformations or small, asymptomatic, capillary angiomas a judgement has to be made as to the appropriateness of treatment and each case assessed individually. There are advantages in treating capillary malformations in young children because of their size and the number of treatments required but this may have to be balanced with the risks associated with general anaesthesia. The views of the parents are of course important. In my experience their concerns are for the well being of their child and when matters have been fully explained and discussed it is usually possible to arrive at a pragmatic decision on management.
1SO22 1 Laser treatment of benign pigmented lesions Nicholas J. Lowe. UCLA Foundation
of California,
School of Medicine, Skin Research USA, Cranley Clinic, London, UK
Introduction: A variety of treatments are used for benign pigmented lesions including surgical removal, chemical peels, dermabrasion, cryotherapy and topical therapy. Clinically or biopsy proven benign melanocytic lesions to be considered for laser therapy: solar lentigo, speckled lentiginous naevus, ephelides, cafe-au-hut lesions, dermal lesions, naevus of Ota, blue naevus, naevus of Ito, and intradermal naevi. Lesions with epidermal plus dermal pigment, compound naevi,
UK
The pulsed dye laser [PDL] wavelength 585 mn and pulse duration of 450 micros is the treatment of choice for port wine stains [PWS]. Complete clearance is infrequent and some patients fail to respond. The only clinical guide to outcome is site of the PWS with leg lesions responding least well. Theoretical observations suggest an ideal pulse duration of
UK
Types of Laser co2 Ho:YAG Nd:YAG Alexandrite Ruby He:Ne
nm 10600 2140 1064 755 694 633
Types of Laser copper-vapor Nd:YAG KTP Argon Excimers
nm 578 532 532 514488 193-351
-
Controversies
Controversies in Del;matological Lasers 1SO18 1 Controversies in dermatological G.E. Allen. City Hospital,
Belfast,
lasers
N Ireland
The use of lasers in dermatological conditions is a rapidly developing and expanding field. Much progress has been made in treating some conditions such as vascular naevi, but many unanswered questions remain, and there are still differing views about which lesions we should be treating. There is also much that we do not fully understand about laser/tissue interaction. This symposium will attempt to address some of the areas of uncertainty, and look at some of the more recent applications for laser treatments in dermatology.
ISO19
Strawberry nevi - To treat or not to treat?
M. Landthaler, U. Hohenleutner. Dept. ofDermatology, University
of Regensburg,
Germany
App. 5% of new-borns suffer from childhood haemangiomas (strawberry nevi). Despite their spontaneous regression, many reports were published in the last decade about the therapy of these benign vascular tumours, either with the flash lamppumped pulsed dye laser (FPDL) or - more rarely- by various Nd:YAG-laser techniques. Additionally, systemic therapy with corticosteroids and IF-o proved to be effective in some patients. Arguments in favour of active therapy are: excellent results in early flat lesions, easy-to-perform therapy, rare side effects of FPDL-therapy, complications of haemangiomas (ulceration, bleeding, involvement of important structures, rapid growth, psychological distress, residual lesions after spontaneous regression), development of haemangiomas is not predictable, extensive lesions may develop from very small and superficial ones and, finally, 60% of lesions do not regress until the age of six. Arguments against therapy are: spontaneous regression in nearly 100% of patients, children of this age are not concerned by their haemangiomas, therapy is painful and does harm to the children, complications of laser therapy, development of deep haemangiomas can not be prevented in all cases and Nd:YAG laser therapy can only be performed in general anaesthesia. Literature of the last ten years as well as our own experience with more than 400 children show that - in our opinion - all initial haemangiomas should be treated. More advanced lesions could be treated if complications do occur or if important structures are involved.
SO20 El
Why do some port wine stains not respond to the pulsed dye laser?
Sean W. Lanigan. Bridgend Wales,
General
Hospital,
Bridgend,
in Dermatological
s9
Lasers
l-10 ms for thermal coagulation of PWS vessels. The 450 micros PDL pulse duration will be too short to coagulate all PWS vessels. Also deeply sited lesions will receive an inadequate light dose. Histological studies of unresponsive PWS have shown ectatic dermal blood vessels empty of red blood cells; the target of this laser. Recent non-invasive studies using a videomicroscopy to assess vascular patterns of PWS have identified patterns of ectasia with good and poor outcomes from treatment which may more accurately predict response to therapy in the future. The results of these investigations in addition to clinical and theoretical observations will be discussed in this presentation.
ISO21
What age should treatment for vascular naevi be started? Are we treating the patient or the parent?
Neil P.J. Walker. FRCR
Churchill
Hospital,
Oxford,
In considering the treatment of vascular naevi a number of factors have to be taken into account. It is of paramount importance to make an accurate diagnosis and on this basis give a prognosis. It is sometimes difficult to be precise but patients and their families are happier when the nature of a naevus and the likely natural course have been explained. In many cases when a lesion is symptomatic, such as a painful angiokeratoma or ulcerated capillary angioma then the indications for treatment are clear and therapy can be instigated as soon as practical. As regards capillary malformations or small, asymptomatic, capillary angiomas a judgement has to be made as to the appropriateness of treatment and each case assessed individually. There are advantages in treating capillary malformations in young children because of their size and the number of treatments required but this may have to be balanced with the risks associated with general anaesthesia. The views of the parents are of course important. In my experience their concerns are for the well being of their child and when matters have been fully explained and discussed it is usually possible to arrive at a pragmatic decision on management.
1SO22 1 Laser treatment of benign pigmented lesions Nicholas J. Lowe. UCLA Foundation
of California,
School of Medicine, Skin Research USA, Cranley Clinic, London, UK
Introduction: A variety of treatments are used for benign pigmented lesions including surgical removal, chemical peels, dermabrasion, cryotherapy and topical therapy. Clinically or biopsy proven benign melanocytic lesions to be considered for laser therapy: solar lentigo, speckled lentiginous naevus, ephelides, cafe-au-hut lesions, dermal lesions, naevus of Ota, blue naevus, naevus of Ito, and intradermal naevi. Lesions with epidermal plus dermal pigment, compound naevi,
UK
The pulsed dye laser [PDL] wavelength 585 mn and pulse duration of 450 micros is the treatment of choice for port wine stains [PWS]. Complete clearance is infrequent and some patients fail to respond. The only clinical guide to outcome is site of the PWS with leg lesions responding least well. Theoretical observations suggest an ideal pulse duration of
UK
Types of Laser co2 Ho:YAG Nd:YAG Alexandrite Ruby He:Ne
nm 10600 2140 1064 755 694 633
Types of Laser copper-vapor Nd:YAG KTP Argon Excimers
nm 578 532 532 514488 193-351