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Laser Treatment of Acquired and Congenital Vascular Lesions

Overview

Laser treatment of cutaneous vascular lesions has progressed significantly over the past 30 years. Based on the pioneering work of Anderson and Parrish in the early 1980s, several vascular-specific laser systems have been developed using principles of selective photothermolysis.

Laser irradiation can selectively destroy specific targets (chromophores) within the skin by using an appropriate wavelength, pulse duration, and energy setting. To limit damage to surrounding structures, pulse duration must be less than or equal to the targeted thermal relaxation time of the chromophore, ie, the time necessary for the target to cool by half of its peak temperature after laser irradiation. Because the energy deposited in the tissue is limited to targeted sites, significant thermal diffusion to adjacent skin is prevented. In addition, because wavelengths corresponding to absorption peaks for various skin chromophores are known, absorption of laser energy can be localized without damaging neighboring structures. The targeted chromophore for vascular lesions is intravascular oxyhemoglobin; thus, thermal damage is largely restricted to cutaneous blood vessels. Major absorption peaks of oxyhemoglobin are at 418, 542, and 577 nm, the latter being optimal.

Early laser technology used continuous-wave (CW) mode lasers for treating cutaneous vascular lesions. These lasers did not restrict damage to the targeted vascular structures, and, consequently, their use resulted in a high prevalence of scarring. Pulsed laser systems, such as the 585- or 595-nm pulsed dye laser (PDL), subsequently were developed and have become the mainstays of therapy for both congenital and acquired vascular lesions. These lasers offer excellent clinical improvement with a low risk of adverse sequelae. Transient purpura is the most common adverse effect of PDL treatment. Current technologic improvements include dynamic surface cooling and extended pulse duration, which enhance clinical results and minimize adverse effects.

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