Laser Treatment in Children

Take Home Message: Vascular and Pigmentary lesions are the most common indications for laser treatments in children (Abstract and Comments below) (Study from Singapore)

Comments:

Lasers are most commonly used in this population group to treat:

–Vascular lesions such as port-wine stains (PWS)

1. Treatment of Vascular lesions are more effective when blood flow is monitored during the treatment
2. Moderate-to-high fluences with long pulse duration are used

–Pigmentary lesions

-To read an article on laser treatment on pigmentary disorders: click HERE 

Abstract

–Vascular lesions can be treated by a variety of light devices including KTP, pulsed dye, alexandrite, diode, Nd:YAG lasers and flashlamp. The pulsed dye laser is the gold standard for the treatment of vascular lesions in children. Numerous sessions are needed to lighten port-wine stains (PWS). Only about 20% of patients obtain complete clearance and PWS recurrence may occur. Strategies to improve results include intraoperative monitoring of blood flow dynamics using laser speckled imaging and addition of anti-angiogenic agents like topical imiquimod and rapamycin. The majority of hemangiomas regresses spontaneously and do not require treatment. The pulsed dye laser is useful in the management of ulcerated hemangiomas, superficial facial hemangiomas and to remove residual telangiectasia after hemangioma involution. In the author’s practice, the use of moderate to high fluences using long pulse duration are used to treat hemangiomas.

–The pigment lasers including the Q-switched ruby (694nm), alexandrite (755nm), Nd:YAG (1064/532nm) are effective in removing pigmented lesions by targeting melanosomes. Pigment laser treatment should be initiated at the threshold fluence, which causes an immediate tissue-whitening effect that signals appropriate energy deposition in the melanosomes. For darker skin tones, the Q-switched Nd:YAG has the lowest incidence of side effects (e.g. hypopigmentation) since its wavelength is more weakly absorbed by melanin than the other laser systems. Recently, the use of a low-fluence Q-switched 1064nm Nd:YAG laser has been used to treat café-au-lait macules and nevus of Ota effectively with fewer side effects. For nevus of Ota resistant to Q-switched Nd:YAG, fractional photothermolysis and the use of a picosecond 755-nm alexandrite laser has been shown to be effective.

-In conclusion, pigment lasers are useful in the treatment of a wide variety of benign pigmented lesions. Careful selection of laser parameters and patient education are pivotal.

Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore. RCD16-0478 Workshop 4: Asian Paediatric Dermatology Workshop Lasers for paediatric dermatological conditions in Asians Y.K. Tay1 1, Singapore