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Capillary Hemangiomas and Treatment with the Flash Lamp-Pumped Pulsed Dye Laser

Capillary Hemangiomas and Treatment with the Flash Lamp-Pumped Pulsed Dye Laser Abstract • Strawberry, or capillary, hemangiomas are common vascular neoplasms, with an incidence of approximately 2.6% in neonates. They usually develop in the first few weeks of life, so that between 1 month and 1 year the incidence rises to between 8.7% and 10.1%. These lesions may grow quite large in the first year of life, and they may ulcerate or obstruct a vital organ or function. The great majority will spontaneously regress after the first year of life. Parents are often alarmed at the sight of these hemangiomas and need reassurance that the great majority will regress spontaneously. Treatments such as cryosurgery, irradiation, radium instillation, corticosteroid therapy, or surgical excision are often ineffective or cause significant morbidity. We describe 10 children with capillary hemangiomas treated with the flash lamp—pumped pulsed dye laser. The patients ranged in age from 7 weeks to 5.5 years at the beginning of laser therapy. The patients underwent 3.1 ± 1 (mean ± SD) laser treatments, with a mean regression of the lesions of 69.9% ±4.5%. All patients demonstrated some diminution in the size and color of their hemangiomas after the treatments, and there were no ill effects, such as ulceration, hemorrhage, infection, or scarring. There was no evidence of hyperpigmentation or hypopigmentation. Pulsed dye laser therapy should be considered as an option in the treatment of capillary hemangiomas, preferably prior to their full evolution. It is also a useful therapeutic approach in those hemangiomas that are slow to regress in older children. (Arch Dermatol. 1991;127:202-205) References 1. Jacobs AH, Walton RG. The incidence of birthmarks in the neonate . Pediatrics . 1976;58:218-222. 2. Bivings L. Spontaneous regression of angiomas in children: twenty-two years' observation covering 236 cases . J Pediatr. 1954;45:643-647.Crossref 3. Jacobs AH. Strawberry hemangiomas: the natural history of the untreated lesion . Calif Med. 1957;86:8-10. 4. Margileth AM, Museles M. Cutaneous hemangiomas in children . JAMA . 1965;194:523-526.Crossref 5. Baker ER, Manders E, Whitney CW. Growth of cavernous hemangioma with puberty . Clin Pediatr. 1985;24:596-598.Crossref 6. Lister WA. The natural history of strawberry naevi . Lancet . 1938;1:1429-1434.Crossref 7. Apfelberg DB, Greene RA, Maser MR, Lash H, Rivers JL, Laub DR. Results of argon laser exposure of capillary hemangiomas of infancy: preliminary report . Plast Reconstr Surg. 1981;67:188-193.Crossref 8. Bowers RE, Graham EA, Tomlinson KM. The natural history of the strawberry nevus . Arch Dermatol. 1960;82:667-680.Crossref 9. Hobby LW. Further evaluation of the potential of the argon laser in the treatment of strawberry hemangiomas . Plast Reconstr Surg. 1983;71:481-485.Crossref 10. Noe JM, Barsky SH, Geer DE, Rosen S. Portwine stains and the response to argon laser therapy: successful treatment and the predictive role of color, age and biopsy . Plast Reconstr Surg. 1988;65:130-136.Crossref 11. Dixon JA, Huether S, Rotering RH. Hypertrophic scarring in argon laser treatment of portwine stains . Plast Reconstr Surg. 1984;73:771-780.Crossref 12. Mulliken JB. Diagnosis and natural history of hemangiomas . In: Mulliken JB, Young AE, eds. Vascular Birthmarks: Hemangiomas and Malformations . Philadelphia, Pa: WB Saunders Co; 1988:41-62. 13. Tan OT, Gilchrest BA. Laser therapy for selected cutaneous vascular lesions in the pediatric population: a review . Pediatrics . 1988;82:652-662. 14. Mulliken JB. Treatment of hemangiomas . In: Mulliken JB, Young AE, eds. Vascular Birthmarks: Hemangiomas and Malformations . Philadelphia, Pa: WB Saunders Co; 1988:89. 15. Friedman M, Strang LB. Effect of long-term corticosteroids and corticotropin on the growth of children . Lancet . 1966;2:568-572.Crossref 16. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed irradiation . Science . 1983;220:524-527.Crossref 17. Tan OT, Sherwood KA, Gilchrest BA. Treatment of children with portwine stains using the flashlamp pulsed tunable dye laser . N Engl J Med. 1989;320:416-421.Crossref 18. Dover JS, Arndt KA, Geronemus RG, Olbright SM, Noe JM, Stern RS. Dye lasers . In: Illustrated Cutaneous Laser Surgery: A Practitioner's Guide . East Norwalk, Conn: Appleton & Lange; 1990:108-120. 19. Reyes B, Geronemus RG. Flashlamp pumped pulsed dye laser treatment of portwine stains in children . J Am Acad Dermatol. 1990;23:1142-1148.Crossref 20. Tan OT, Murray S, Kurban AK. Action spectrum of vascular specific injury using pulsed irradiation . J Invest Dermatol. 1989;92:868-871.Crossref 21. Sherwood KA, Tan OT. Treatment of a capillary hemangioma with the flashlamp pumped-dye laser . J Am Acad Dermatol. 1990;22:136-137.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Capillary Hemangiomas and Treatment with the Flash Lamp-Pumped Pulsed Dye Laser

Archives of Dermatology , Volume 127 (2) – Feb 1, 1991

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1991.01680020070007
Publisher site
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Abstract

Abstract • Strawberry, or capillary, hemangiomas are common vascular neoplasms, with an incidence of approximately 2.6% in neonates. They usually develop in the first few weeks of life, so that between 1 month and 1 year the incidence rises to between 8.7% and 10.1%. These lesions may grow quite large in the first year of life, and they may ulcerate or obstruct a vital organ or function. The great majority will spontaneously regress after the first year of life. Parents are often alarmed at the sight of these hemangiomas and need reassurance that the great majority will regress spontaneously. Treatments such as cryosurgery, irradiation, radium instillation, corticosteroid therapy, or surgical excision are often ineffective or cause significant morbidity. We describe 10 children with capillary hemangiomas treated with the flash lamp—pumped pulsed dye laser. The patients ranged in age from 7 weeks to 5.5 years at the beginning of laser therapy. The patients underwent 3.1 ± 1 (mean ± SD) laser treatments, with a mean regression of the lesions of 69.9% ±4.5%. All patients demonstrated some diminution in the size and color of their hemangiomas after the treatments, and there were no ill effects, such as ulceration, hemorrhage, infection, or scarring. There was no evidence of hyperpigmentation or hypopigmentation. Pulsed dye laser therapy should be considered as an option in the treatment of capillary hemangiomas, preferably prior to their full evolution. It is also a useful therapeutic approach in those hemangiomas that are slow to regress in older children. (Arch Dermatol. 1991;127:202-205) References 1. Jacobs AH, Walton RG. The incidence of birthmarks in the neonate . Pediatrics . 1976;58:218-222. 2. Bivings L. Spontaneous regression of angiomas in children: twenty-two years' observation covering 236 cases . J Pediatr. 1954;45:643-647.Crossref 3. Jacobs AH. Strawberry hemangiomas: the natural history of the untreated lesion . Calif Med. 1957;86:8-10. 4. Margileth AM, Museles M. Cutaneous hemangiomas in children . JAMA . 1965;194:523-526.Crossref 5. Baker ER, Manders E, Whitney CW. Growth of cavernous hemangioma with puberty . Clin Pediatr. 1985;24:596-598.Crossref 6. Lister WA. The natural history of strawberry naevi . Lancet . 1938;1:1429-1434.Crossref 7. Apfelberg DB, Greene RA, Maser MR, Lash H, Rivers JL, Laub DR. Results of argon laser exposure of capillary hemangiomas of infancy: preliminary report . Plast Reconstr Surg. 1981;67:188-193.Crossref 8. Bowers RE, Graham EA, Tomlinson KM. The natural history of the strawberry nevus . Arch Dermatol. 1960;82:667-680.Crossref 9. Hobby LW. Further evaluation of the potential of the argon laser in the treatment of strawberry hemangiomas . Plast Reconstr Surg. 1983;71:481-485.Crossref 10. Noe JM, Barsky SH, Geer DE, Rosen S. Portwine stains and the response to argon laser therapy: successful treatment and the predictive role of color, age and biopsy . Plast Reconstr Surg. 1988;65:130-136.Crossref 11. Dixon JA, Huether S, Rotering RH. Hypertrophic scarring in argon laser treatment of portwine stains . Plast Reconstr Surg. 1984;73:771-780.Crossref 12. Mulliken JB. Diagnosis and natural history of hemangiomas . In: Mulliken JB, Young AE, eds. Vascular Birthmarks: Hemangiomas and Malformations . Philadelphia, Pa: WB Saunders Co; 1988:41-62. 13. Tan OT, Gilchrest BA. Laser therapy for selected cutaneous vascular lesions in the pediatric population: a review . Pediatrics . 1988;82:652-662. 14. Mulliken JB. Treatment of hemangiomas . In: Mulliken JB, Young AE, eds. Vascular Birthmarks: Hemangiomas and Malformations . Philadelphia, Pa: WB Saunders Co; 1988:89. 15. Friedman M, Strang LB. Effect of long-term corticosteroids and corticotropin on the growth of children . Lancet . 1966;2:568-572.Crossref 16. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed irradiation . Science . 1983;220:524-527.Crossref 17. Tan OT, Sherwood KA, Gilchrest BA. Treatment of children with portwine stains using the flashlamp pulsed tunable dye laser . N Engl J Med. 1989;320:416-421.Crossref 18. Dover JS, Arndt KA, Geronemus RG, Olbright SM, Noe JM, Stern RS. Dye lasers . In: Illustrated Cutaneous Laser Surgery: A Practitioner's Guide . East Norwalk, Conn: Appleton & Lange; 1990:108-120. 19. Reyes B, Geronemus RG. Flashlamp pumped pulsed dye laser treatment of portwine stains in children . J Am Acad Dermatol. 1990;23:1142-1148.Crossref 20. Tan OT, Murray S, Kurban AK. Action spectrum of vascular specific injury using pulsed irradiation . J Invest Dermatol. 1989;92:868-871.Crossref 21. Sherwood KA, Tan OT. Treatment of a capillary hemangioma with the flashlamp pumped-dye laser . J Am Acad Dermatol. 1990;22:136-137.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Feb 1, 1991

References