Laser therapy of spider leg veins: Clinical evaluation of a new long pulsed alexandrite laser

BACKGROUND. The response of spider leg veins to laser or intense pulsed lig ht therapy has generally been characterized by varying degrees of success a nd frequently inconsistent clinical response rates. OBJECTIVE. The purpose of this study was to examine the effectiveness of th e 755 nm long pulsed infrared alexandrite (LPA) laser for the treatment of leg telangiectasias. METHODS. This Study was constructed in four phases. Phase I examined 28 pat ients with variable sized telangiectasias using 5 treatment parameters (15 J/cm(2) x 1 pulse, 20 J/cm(2) x 1 pulse, 20 J/cm(2) x 2 pulses, 20 J/cm(2) x 3 pulses, or 30 J/cm(2) x 1 pulse). Each patient received 3 treatments at 4 week intervals with the LPA. Patient diaries were obtained to examine th e effects of the treatments. Subjective grading was performed at each follo w-up visit by the investigators. Blinded objective grading was performed at the conclusion of the study by trained observers. Phase II examined the ef fects of these treatment parameters on varying vessel diameters. Vessels we re grouped into small(<0.4 mm), intermediate (0.4-1.0 mm), and large (1.0-3 .0 mm) subsets. Phase III examined the effects of a combination of LPA trea tment followed by 23.4% hypertonic saline sclerotherapy. Subjective and bli nded objective grading was used to determine improvement after a single tre atment with the LPA at 20 J/cm(2), single pulsed with a pulse duration of 5 or 10 msec followed by treatment with 23.4% hypertonic saline injected 3, 7, 14, or 28 days after laser therapy. Phase IV involved biopsies after LPA treatment alone at time intervals of immediately posttreatment and 5 and 2 1 days posttreatment. RESULTS. These evaluations revealed that the optimal treatment parameters f or LPA therapy alone appeared to be 20 J/cm(2), double pulsed at a repetiti on rate of one Hz. After 3 treatments at 4 week intervals, subjective gradi ng indicated a 63% reduction in leg telangiectasias. Medium diameter vessel s responded best with small vessel diameters responding poorly, if at all. The addition of 23.4% hypertonic saline sclerotherapy performed 3 to 7 days after laser therapy (LPA at 20 J/cm(2), single pulsed with a pulse duratio n of 5 msec) produced 87% reduction in leg telangiectasias. Biopsies after LPA treatment revealed vessel wall endothelial cell necrosis at 5 days with fibrosis occurring at 3 weeks. The optimal clinical "window" for sclerothe rapy seems to coincide with the period of endothelial cell necrosis. CONCLUSION. LPA therapy is most effective for leg telangiectasias 0.4-3.0mm in diameter. This LPA technique is significantly improved with the additio n of sclerotherapy.