Flashlamp-pumped pulsed dye laser for hemangiomas in infancy - Treatment of superficial vs mixed hemangiomas

Objective: To study in a compared manner the efficacy of flashlamp-pumped p ulsed dye laser (FPDL) therapy for superficial and mixed hemangiomas. Design: Nonrandomized control trial. Setting: Department of Lasermedicine, General Hospital Neukolln, Berlin, Ge rmany. Patients: To investigate variation in response to treatment, a prospective study of 165 children with 225 separate hemangiomas treated with the FPDL w as undertaken. Patients were aged 2 days to 7 years; mean follow-up was 5 m onths. Interventions: During a 2 1/2-year period, we administered 332 treatments, for a mean+/-SD of 2.0-1.1 treatments per patient. Main Outcome Measure: Patients received therapy until the lesion was almost clear or until the lesion did not respond to treatment. Evaluation was per formed by comparing pretreatment and posttreatment photographs. In addition , pathologic flow of vessels and thickness were determined before, during, and after completion of therapy with color-coded duplex sonography. Results: In the first group of 100 patients with 153 flat cutaneous hemangi omas, 52 hemangiomas (34%) had excellent results; 80 (52%) had good results ; and 21 (14%) showed proliferation of the subcutaneous component, although these lesions were Rat at first presentation. Of the 54 mixed hemangiomas, 33 (61%) had continued proliferation of the subcutaneous component. The cu taneous component responded to therapy in 21 hemangiomas (39%), whereas the subcutaneous component of the mixed hemangiomas remained unchanged. No les ions in this group involuted completely, and therapy was discontinued becau se of relatively poor response. Twelve (67%) of 18 patients with superficia l hemangiomas in the involution phase had excellent results and 6 (33%) had good results. Conclusions: Treatment with the FPDL is effective and may be the treatment of choice for superficial cutaneous hemangiomas at sites of potential funct ional impairment and on the face. Hemangiomas with a deep component do not benefit from FPDL treatment because the efficacy of the FPDL is limited by its depth of vascular injury. Furthermore, early therapeutic intervention w ith the FPDL may not prevent proliferative growth of the deeper or subcutan eous component of the hemangioma despite early intervention.