Laser ND-YAG à impulsion de durée allongée pour le traitement des télangiectasies

Clinical experience in the treatment of different vascular lesions using a neodymium-doped yttrium aluminum garnet laser.

Civas E, Koc E, Aksoy B, Aksoy HM.

Dermatol Surg. 2009 Dec;35(12):1933-41.

• This article is interesting because it highlights the efficacy of the treatment of telangiectasia and spider angiomas. Long pulsed NDYAG has mainly been shown to be effective in the treatment of deeper small veins and long term hair removal (amongst other indications). Its mode of action is in the mid dermis where many lasers and other light sources have difficulty reaching (4 to 5mm). Thanks to cooling, the epidermis tends to be less affected.
• The authors describe successful treatment of vascular lesions (port wine stains, hemangniomas, telangiectasia, other vascular lesions) out  of 105 patients. Clinical response was evaluated by a dermatological laser surgeon on photographs:

1. 0-25% no improvement
2. 26-50% mild improvement = fair
3. 51-75% moderate improvement = good
4. 76-100 % significant improvement = excellent

• Patient satisfaction was also evaluated during the final visit:

1. not satisfied
2. little satisfied
3. moderately satisfied
4. satisfied
5. very satisfied

• Results are available in the article for the other vascular lesions but we would like to focus on the telangiectasia treatment which concerned 48 patients:

1. mean age was 41.2 years old
2. 37 patients were female
3. In 13 patients, lesions were on the face, in the other 35 were on the leg
4. the average number of treatments was 2.4
5. fluence was 140-210 J/cm2
6. spot size was 3-5mm
7. pulse duration was 10-15ms
8. RESULT: A good to excellent response was observed in two thirds of the cases. Out of all vascular lesions treated 58% were satisfied to very satisfied, 20% were somewhat satisfied, 10% were little satisfied, 12% were not satisfied.
9. SIDE EFFECTS: Out of all lesions treated. Erythema, erosions, burning and crusting were infrequently observed and erosions were treated with a topical antibiotic twice a day for a week. Vesiculation and erosion were more observed when the fluence was higher and the pulse duration lower. Erosions healed with pigmentation changes, atrophic scarring (4 cases) were observed if the erosions were deeper, hyperpigmentation was seen in 6 cases, hypopigmentation in 3 cases. The total of side effects is therefore seen in around 12% of cases.

• To conclude, 13 patients were treated for facial telangiectasias and 35 for leg telangiectasia and a good to excellent was observed in two-thirds of the treated patients. This is lower than in the literature (see article) (except for Bevin’s work where improvement is only seen in 50% of cases).