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The New 940-Nanometer Diode Laser: an Effective Treatment for Leg Venulectasia

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The New 940-Nanometer Diode Laser: an Effective Treatment for Leg Venulectasia LASER SURGERY The new 940-nanometer diode laser: An effective treatment for leg venulectasia Thierry Passeron, MD,a Vale´rie Olivier, MD,a Luc Duteil, MD,b Franc¸ois Desruelles, MD,a Eric Fontas, MD,c and Jean-Paul Ortonne, MDa Nice, France Background: The 940-nm diode laser has been shown to be an effective treatment for leg veins. Objective: We sought to evaluate the effectiveness of the 940-nm diode laser on leg veins, depending on the size and morphologic aspect of the treated vessels. Methods: A total of 60 patients (mean age: 44.4 years, Fitzpatrick skin types I-IV) underwent up to 3 treatment sessions at 4-week intervals using the 940-nm diode laser. Treatment parameters were: vessels Ͻ 0.4 mm in diameter, 0.5-mm spot, pulse duration of 10 milliseconds, fluence 306 J/cm2; 0.4 to 0.8 mm in diameter, 1-mm spot, pulse duration of 30 milliseconds, fluence 306 J/cm2; and 0.8 to 1.4 mm in diameter, 1.5-mm spot, pulse duration of 70 milliseconds, fluence 317 J/cm2. Repetition rate was 2.5 Hz. Success rate was evaluated through double-blind observation. Results: Only 13.33% of patients with telangiectases less than 0.4 mm in diameter had a percentage of vessel clearance superior to 75%. However, 88.24% of patients with vessels between 0.8 and 1.44 mm in diameter obtained more than 75% vessel clearance. Conclusion: The treatment of leg veins by the 940-nm diode laser strongly depends on the size of the target vessel. Better results were obtained with 0.8- to 1.4-mm leg venulectases. (J Am Acad Dermatol 2003;48: 768-74.) eg telangiectases are represented by an ex- Since the development of laser technology in panded venule, capillary, or arteriole. The dermatology, vascular indications such as port wine L clinical aspects and physiopathology are quite stains or spider angioma have been treated success- different within each variety of telangiectases. Color, fully. As an alternative method, leg telangiectases depth, diameter, and placement define the various were also treated, but results were less convincing. categories of telangiectases.1-3 Superficial telangiec- Laser beams in the wavelength range of 500 to 600 tasia, venulectasia, and reticular veins measuring, nm such as KTP, frequency-doubled neodymium: respectively, 0.1 to 0.3 mm, 0.4 to 2 mm, and 2 to 4 yttrium-aluminum-garnet, and long pulsed dye la- mm in diameter represent 3 distinct target vessels. sers have been used for the high absorption of Treatment strategy must be modified to achieve hemoglobin in these wavelengths.6-11 Clinical re- greater success. Sclerotherapy combined with a va- sponse rates reported were inconsistent, and ad- riety of agents is considered the gold standard treat- verse effects were comparable and sometimes sig- 4,5 ment for leg telangiactasias. However, pain, pig- nificantly greater than those achieved by ment changes, ulceration, scarring, and sclerotherapy. However, better results were ob- telangiectatic matting may result. tained when treating superficial telangiectases with a diameter less than 0.5 mm. The relatively large From the Department of Dermatology,a Centre de Pharmacologie diameter and the depth of some telangiectases pre- b Clinique Applique´ea` la Dermatologie, and Centre d’Information vented the complete coagulation of the vessels. La- et de Soins de l’Immunode´ficience Humaine,c Archet-2 Hospital. Funding sources: None. sers emitting longer wavelengths, such as long- 12,13 Conflict of interest: None identified. pulsed alexandrite, neodymium:yttrium- Reprint requests: Jean-Paul Ortonne, MD, Department of Dermatol- aluminum-garnet,14,15 and 800- and 810-nm ogy, Archet-2 Hospital, BP 3079, 06202 Nice, CEDEX 3, France. diode16-18 lasers, had previously produced some fa- E-mail: [email protected]. vorable responses to this treatment. The 940-nm Copyright © 2003 by the American Academy of Dermatology, Inc. 0190-9622/2003/$30.00 ϩ 0 diode laser has interesting possibilities for the treat- doi:10.1067/mjd.2003.191 ment of leg telangiectases. However, only 46% of 768 JAM ACAD DERMATOL Passeron et al 769 VOLUME 48, NUMBER 5 patients in a recent study achieved 75% clearing.19 sel disappearance without blanching of the epider- The objective of this study was to evaluate the ef- mis. The study involved treatment of entire length of fects of the 940-nm diode laser on a large group of the vessels until they were no longer visible. No patients, depending on size and morphologic aspect cooling device was used. Postlaser care consisted of the treated vessels. Long-term results and occur- only of taping emollient cream. Patients returned for rence of side effects were also studied. follow up treatment every 4 weeks, for a total of 3 treatments. A final visit was scheduled 4 weeks after MATERIALS AND METHODS the final treatment. Patients were re-evaluated 1 year A total of 60 patients seeking treatment for leg later to determine the long-term effectiveness of the telangiectases were enrolled in the prospective treatment. study after obtaining written consent. Patients Patients were instructed to rate the pain per- ranged in ages from 25 to 75 years with the mean ceived during treatment on a visual scale of 1 to 10, age being 44.4 years and the minimum age being 18 with 1 representing minimal discomfort and 10 rep- years. Of the patients, 58 were women. Fitzpatrick resenting severe pain. Complications including hy- skin type among patients was I (4), II (18), III (35), perpigmentation, erythema, telangiectatic matting, and IV (3). Patients having Fitzpatrick skin type V purpura, crusting, and scarring were recorded be- and VI were excluded. All categories of telangiecta- fore each new laser se´ance and at the final visit. ses were included (linear, arborized, and spider). Photographs were taken before treatment, after Spider telangiectases were differentiated from ar- each session, and at the final visit. A Polaroid Macro borized telangiectases by virtue of a perforating 5 SLR magnifying X1 and X3 was used with identical venule in the center. Treatment sites were varied to parameters on each occasion. Evaluation was done study different locations on the lower extremities. by 2 physicians who reviewed in a blinded manner Calculating distances in millimeters, and the exact the photographs of each patient. For each patient, treatment sites for clinical, photographic, and Dopp- the percentage of vessel clearance was estimated ler flow evaluations were noted for each patient and an average of these 2 evaluations was made. A from different anatomic marks. They were then pre- laser Doppler perfusion imager (PIM 1.0, Lisca De- cisely located on tracing paper where the telangiec- velopment AB, Linko¨ping, Sweden) was used to ϫ tases, naevi, lentigo, and other selected natural scan the selected area (2.5 2.5 cm) before each marks were reproduced to allow precise identifica- laser se´ance and at the final visit to study the evo- tion of the treatment site during the course of the lution of the spatial distribution of the skin perfu- study. Personal history of sclerotherapy was noted. sion. Finally, each patient who had previously un- Pregnancy, lactation, poor healing, previous sclero- dergone sclerotherapy was asked to compare the 2 therapy, or other laser therapy for leg veins within methods as to their effectiveness and level of pain. the last 2 months, and a history of deep or superficial vein thrombosis were all criteria of exclusion. Pa- RESULTS tients were instructed to shave their legs before each Of the 60 patients, 52 returned for all posttreat- laser session and to avoid sun exposure until 6 ment evaluations. A total of 6 patients were unable weeks after the last treatment. to tolerate the pain and 2 patients decided to stop Patients were treated by a 940-nm diode laser after 1 se´ance because of no improvement. These (Dornier Medilas D, SkinPulse). Both fluence and patients were all considered to have had ineffective pulse duration were selectable within a range of 200 treatment (clearance rates 0%-25%). The degree of to 1000 J/cm2 and 10 to 100 milliseconds, respec- concordance between the 2 observers was evalu- tively. Three hand pieces allowed the delivery of ated by linear weighted ␬. The ␬ was very good laser energy with 0.5-, 1-, and 1.5-mm diameter spot (0.91). Only 13.33% of patients with telangiectases sizes. Telangiectases less than 0.4 mm in diameter less than 0.4 mm in diameter had a vessel clearance were treated by a 0.5-mm spot with a pulse duration of more than 75%. However, 88.24% of patients with of 10 milliseconds. For telangiectases between 0.4 vessels between 0.8 and 1.4 mm in diameter ob- and 0.8 mm in diameter, a 1-mm spot with a pulse tained more than 75% vessel clearance. Complete duration of 30 milliseconds was used, and a 1.5-mm vessel clearance (Ͼ95%) was obtained only in the spot with a pulse duration of 70 milliseconds was group with vessels between 0.8 to 1.4 mm in diam- used for telangiectases between 0.8 to 1.4 mm in eter. In this group, 35.3% (6 of 17) patients obtained diameter. Repetition rate was 2.5 Hz. Each proce- complete vessel clearance. The results of the 940-nm dure involved a fluence of 306 J/cm2 when the 0.5- diode laser in 60 patients are summarized in Figs 1 to or 1-mm spot was used and 317 J/cm2 with 1.5-mm 3. Examples of pretreatment and posttreatment pho- spot.
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