Clinical Bulletin No. 1

Vbeam™ Pulsed Dye Laser Treatment of of Civatte

Stephen W. Eubanks, M.D. Dermatology & Laser Center, Denver, Colorado, USA

Introduction

Poikiloderma of Civatte, first described This early laser success suggested in 1923 by a French dermatologist1, is a that newer lasers would be even combination of , telangiectasia more effective in treating this trouble- and irregularities in pigmentation. This some condition. pigmentary change is usually a brownish Method red reticulated pigmentation. At one Stephen W. Eubanks, M.D. time this disorder was felt to be due After signing an informed consent for to a hormonal abnormality and limited pulsed dye laser treatment, patients to menopausal and post-menopausal were treated with the Vbeam laser using women. It is now understood to be a the 10 mm round spot. The parameters result of chronic sun damage and affects were 595 nm light, 10 ms pulse duration, both men and women with excessive sun between 5.0 and 6.5 J/cm2 with exposure. This is often found on the the Dynamic Cooling Device™ either off or cheeks and lateral neck and may extend set with a spray of 30 ms and a delay of well down onto the chest. The submental 20 ms. The entire involved area was area is conspicuously spared. treated in each session. The number of pulses was dependent on the total area Treatments in the past have been of involvement. A SecondSkin® dressing largely ineffective. These have included was applied after the treatment and left electrocautery, chemical peels and argon in place for three hours. Patients were lasers. The pulsed dye laser with a treated a total of two or three times, all 585 nm wavelength, a 5 mm spot size with similar parameters. and a 360 ms pulse duration was shown to be effective in one patient2. The Results limitations were the small spot size and There was a greater than 75% improve- the significant purpura that followed the ment in all fifteen of the patients treated. laser treatment. See the following figures 1 and 2. Figure 1 Figure 2

Pre-treatment After two treatments at four-week intervals

There was no post-operative purpura at the settings used. There were no side is a combina- effects noted in any of these patients. tion of both and Discussion telangiectasia in a setting of generalized solar damage. It is unclear why the There have been an abundance of pulsed dye laser appears to be effective articles published demonstrating the in treating both the telangiectatic effectiveness and safety of pulsed dye component and some of the hyperpig- lasers for treating vascular disorders mentation but this has been shown in such as port wine stains in children and both our patients and in the previously adults, proliferative hemangiomas in published study with the 585 nm, short children, facial telangiectasia, leg veins pulsed laser. and telangiectatic rosacea. In summary, the Vbeam pulsed dye Although there are other lasers that laser appears to be an extremely effective are effective in treating some of these modality to treat Poikiloderma of Civatte. vascular conditions, the pulsed dye laser There is minimal post-operative purpura, was chosen to treat patients with good results and very little risk of Poikiloderma of Civatte because of its adverse effects. effectiveness and safety. The neck area has always been considered a more risky Bibliography area to treat than the face due to poorer 1. Civatte A. Poikilodermie reticulée pigmentarie du visage et du cou. Ann Dermatol Syphiligr healing and an increased risk of scarring. (Paris) 1923; 4:605-620.

There have been no reports in the 2. Wheeland RG, Applebaum J. Flashlamp- literature of scarring on the neck with pumped pulsed dye laser therapy for Poikiloderma of Civatte. J Dermatol pulsed dye lasers and no evidence in Surg Oncol 1990; 16:12-16. our treatments.

Vbeam is a trademark of Candela Corporation. Dynamic Cooling Device (DCD) is a trademark. 530 Boston Post Road SecondSkin is a registered trademark of Spenco Medical Corp. Wayland, MA 01778 To find out more about Candela and its products, contact your authorized Candela representative, Phone: 508-358-7637 or call 1-800-733-8550 in the USA. Outside the USA, contact the office nearest you or Fax: 508-358-5569 visit our website at http://www.vbeam.com. 0920-23-0056 Rev. 02 10/01