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Treatment of Vascular Lesions

Vascular lesions comprise of a collection of skin conditions that have the common characteristic of an abnormal collection of blood vessels. These lesions may be congenital or acquired. Although usually not serious they can be the focus of considerable ridicule in children and embarrassment in adults.

The VersaPulse laser system can achieve highly selective vascular damage, thereby minimising damage to surrounding normal tissue.

The laser is revolutionary in that it has a cooled-tip, which allows pulse duration's of up to 50 ms to be achieved. It has been shown in numerous studies that at least 10 ms is required to be effective in treating many vascular lesions. Experience with this laser has shown that fewer treatment sessions are required (when compared to other laser systems) and that it can be effective in treating lesions previously resistant to other methods. In addition it has the added benefit of less bruising and less pain than Dye laser treatments.

What can be done?

Previously vascular lesions were poorly treated by modalities other than laser treatment. We now have the facility to treat all of the following conditions:

What are the consequences?

In contrast to other types of "vascular lesion laser" bruising will be minimal. Immediately after the treatment there will be minimal change in the appearance of the vascular lesion. It is normal for the treated area to be swollen (like a nettle rash) with a surrounding area of redness for up to 24 hours after each treatment session. There may be a little superficial crusting following but gradual improvement over the next 10 - 14 days.

The laser induces a thrombosis within the vessels of the lesion and these take time to clear. There may be an initial darkening of the lesion.

In the lower leg these skin changes may take six weeks or more to settle.

What are the limitations?

Although for the majority of lesions there is a table of settings that work for most patients, it may be necessary to perform a number of test patches to determine the optimum setting of the laser. The test patches will have to be assessed eight weeks later. Some very thick vascular lesions may not respond at all.

Most lesions will require more than one treatment session. The number of sessions required will depend on the thickness of the problem and the expectations of the patient. Some patients are happy with lightening of the majority of the vascular malformation. Most red scars and spider naevi are treatable in one or two sessions. It is necessary to leave a minimum of eight weeks between each treatment session.

Complete clearance of all lesions cannot be guaranteed. Reasonable expectation of the outcome must be discussed with your practitioner prior to commencing your treatment.

If the lesion is associated with an overlying skin irregularity, then it is unlikely that the laser beam will affect it. Further alternative methods may be discussed with your surgeon.

The VPW laser works best for fine vessels. Larger vessels may need to be treated by Sclerotherapy. Please see the appropriate leaflet for more information.

What are the risks?

As with all laser treatments there is a small risk of scarring. Although there is no evidence to suggest problems, we prefer not to treat you if you are pregnant. It is possible to lose pigmentation in the skin. This will leave pale patches at the site of the treatment. This loss of pigmentation may not be apparent until the treatment has been completed and may be permanent.

What you should do before the treatment

You should avoid sun-beds and sunbathing for at least one month before the treatment. The laser light is absorbed by skin pigment and in tanned skin there is an increased risk of blistering and scarring, as well as a greater risk of losing pigment in the skin. The darker your skin, the more painful the laser treatment will be.

What you can expect at the time of your treatment

Most procedures can be carried out without the need for any anaesthetic. The tip of the laser is cooled to 4°C and feels cold when applied to the skin. This helps to reduce the discomfort. Each pulse of the laser feels like an elastic band being snapped against the skin. Most patients are able to tolerate this. For large areas, or in patients who are unable to tolerate the discomfort, a local anaesthetic cream (Amitop) can be applied to the skin for up to two hours before the start of treatment. This will greatly reduce the discomfort of the treatment but will not remove it completely. The only discomfort experience afterwards is similar to that of mild sunburn.

It is necessary to apply the cooling chamber at the end of the laser to the skin to minimise the risk of skin damage. In awkward areas such as the side of the nose firm pressure must be applied. This should cause no more than mild discomfort.

What you should do when you go home

The treated area may blister. You should be careful when washing not to damage the delicate healing skin. If the treated area is in the hairline, extra care must be taken when combing or brushing. Do not apply heavily perfumed soap or irritant solutions until two weeks after the treatment session. It is advisable to avoid vigorous exercise and very hot baths for two weeks after the treatment.

If the treated area becomes crusty or dry you may apply a simple moisturiser to the skin from the day after you have had the laser treatment. If the area is exposed to sunshine then apply a high sun protection factor cream each morning for six months and reapply as indicated through the day.

If you have had laser treatment to veins on the legs then these will take longer to fade. If you develop bruising or discoloration then this can be disguised with the use of skin tone concealer. Brown discoloration may take anything up to a year to fade.

Conclusion

This latest laser technology has significantly improved the results from treating these complex problems. The laser therapy can be done without any form of anaesthetic and often requires a course of treatment. Although complete clearance of the problem cannot be guaranteed, significant improvement is likely.