Treatment of telangiectasia using the multi-pass technique with the extended pulse width, pulsed dye laser (Cynosure V-Star)

Abstract

The pulsed dye laser (PDL) has been used for the treatment of facial and leg telangiectasia, where it provides safe and effective treatment. Often, a single treatment with the PDL can provide acceptable vessel clearance. Unfortunately, the hallmark of PDL treatment is transient purpura, which can be cosmetically unacceptable to patients. A new class of PDL has been developed in an effort to reduce this transient side effect while maintaining both safety and efficacy. To evaluate the ability of multi-pass treatment for telangiectasia with extended pulse width (40 ms) PDL to provide effective, single-treatment vessel treatment without inducing purpura. A total of 40 patients presenting with facial or leg telangiectasia were treated with the extended pulse width PDL (595 nm), used in conjunction with refrigerated air-cooling (SmartCool; Cynosure). Treatment was given using a pulse width of 40 ms and fluences at or below the purpuric threshold (less than 16 J/cm(2)) and with high-flow air cooling at -4 degrees C. Up to three passes were given until vessel disappearance or intravascular coagulation was observed. A second treatment was done, where needed, 4-8 weeks following the initial treatment. Patients were evaluated 4, 8, and 12 weeks after the final treatment. Following a single treatment, 70% of facial and 80% of leg vessels exhibited at least 75% clearance. After two treatments, 14/20 leg vessels cleared at 75-100%. In all cases, vessel clearance was associated with transient purpura lasting less than 7 days. Hyperpigmentation occurred in 5% of facial vessels and 55% of leg veins. Sub-purpuric doses did not provide acceptable single-treatment clearance. Extended pulse width dye lasers significantly increase the threshold for purpura, allowing higher fluences to be employed. For the goal of single treatment vessel clearance, the extended pulse duration provided acceptable, single-treatment improvement but only in the presence of purpura. While additional, non-purpuric treatments may provide acceptable outcomes, additional improvements will be necessary to provide consistent, effective, single-treatment clearance of telangiectasia without generalized purpura.