Recurrence of Spider Angiomas After Laser Treatment
In this study, 36% of treated patients experienced recurrence, but newer lasers may produce better results.
Pulsed dye laser (PDL) photocoagulation is generally thought to be highly effective for treating spider angiomas. In this prospective study from England, all 201 patients presenting with spider angiomas to an outpatient laser center underwent treatments with a PDL (585-nm wavelength, 0.45-ms pulse duration) every 2 months until complete lesion resolution. The patients were randomized to one of two treatment protocols: a single 3-mm pulse at 12 J/cm2 or one 3-mm pulse at 8 J/cm2 followed by one 5-mm pulse at 6.4 J/cm2. All 191 patients who had complete resolution of the spider angiomas were contacted by a mail survey regarding recurrence.
Total lesion clearance occurred in 95% of patients regardless of anatomic site, presence or absence of flare, presence or absence of a bulky feeder vessel, and use of either treatment protocol. The mean number of treatments to lesion clearance was 1.84 (range, 1–7). Larger lesions required more treatment sessions to clear. Of the 138 responders to the mail survey, 36% reported recurrence of treated angiomas after a mean follow-up of 38 months. Higher risk for recurrence was associated with older age, lesion location on the peripheral face, absence of a feeding vessel, and presence of a bulky feeding vessel. Hypopigmentation was reported by 15% of patients and hyperpigmentation by 7%. The complication rate increased with an increasing number of treatments. Three quarters of responders were satisfied with their results, and all but 5% would have more treatments if needed.
Comment: Use of the first-generation PDLs with short pulse durations, small spot size, high fluence, and short wavelengths produced very high spider angioma recurrence and complication rates. The latest PDLs have large spot sizes and longer wavelengths for greater depth of penetration, longer pulse durations for better matching to the feeding vessels size, and epidermal cooling to reduce complications and allow safe use of higher fluences. These developments may account for the far-lower rates of recurrence and complications seen in clinical practice than reported here.
Published in Journal Watch Dermatology July 20, 2007
Sivarajan V et al. Recurrence of spider naevi following treatment with 585 nm pulsed dye laser. J Plast Reconstr Aesthet Surg 2007 Jun; 60:668-71.
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