Treatment of hemangiomas with 595 nm pulsed dye laser dermobeam.

The third generation dye lasers are pulsed dye lasers with a wavelength of 595 nm. Hemangiomas are the most common benign tumor in infancy, and ulceration is their most frequent complication. We used a 595 nm, Dermobeam 2000 laser (from Deka MELA Calenzano, Italy), using a dynamic skin cooling system (Spray) as the cooling method. The diameter of the spots was 7 mm, the energy density (fluence J/cm2) from 4 to 8 J/cm2. The emission modality (repetition rate) was repeated at 0.5 Hz. We initially chose a long pulse duration of 30 msec, but in the majority of cases it was 0.5 msec. The SmartSpray Cooling system parameters were : freezing, flood, duration, and advance. The spray length was from 60%. The delay (advance or anticipation) was 10 msec. The anesthetic effect limited the need for additional topical, local or general anesthetic. In a prospective study, we treated 16 patients with 22 cutaneous hemangiomas from July 2000 to February 2002 (over a 19 month period), with a mean follow up of 22.44 months (10 to 42 months). Our purpose was to review the therapeutic response of ulcerated hemangioma to the third generation pulsed dye laser. The female/male sex ratio was approximately 3 :1 (12 girls, and 4 boys). Patients were aged from 1 to 15 months, for a mean of 4.9 months. We tried to evaluate the therapeutic response of ulcerated hemangiomas to 595 nm wavelength pulsed dye laser. We observed no adverse effects; however 2 failures due to pain were recorded from ulcerated hemangiomas as the severity of the subcutaneous component of the mixed hemangiomas remained unchanged. These 2 cases showed proliferation of the subcutaneous component, and required general corticosteroids. We examined the children about 10 to 15 days after the first treatment, and evaluated the residual pain. The treatment could be continued while the pain level is low (1 session in most cases), and until the ulceration heals (after 4 sessions). Laser therapy was always effective on severe bleeding, but recurrences were frequent and it was necessary to treat hemangiomas until the end of the cicatrisation. Laser therapy is indicated for hemangiomas only in rare instances : due to the refractory ulceration failing to heal after 2 weeks of specialized dressing, aesthetic risk due to localization (such as philtrum, columella, or nasal margin). It is also possible to treat residual telangiectasia. No uniformly effective treatment modality was found.