Infantile hemangiomas (IH) are common benign tumors of infancy that most resolve in early infancy, some persist, require treatment with systemic oral propranolol solutions, and most are severe. lead to significant improvements. However, it should be noted that recent studies have shown unsatisfactory results for some of his IHs.18,19.
Furthermore, recurrence of IH occurs in up to 25% of treated children after successful initial propranolol treatment. Her 10–15% of these patients required repeat treatment with propranolol.20,21,22,23,24,25,26,27,28,29,30Additionally, in rare cases, propranolol can cause side effects such as hypoglycemia, hypotension, bradycardia, diarrhea, and hyperkalemia. not have needs.
Laser treatment options are particularly important in providing additional therapy for patients with residual and recurrent hemangiomas, as well as those at risk of propranolol contraindications or side effects. Numerous studies of PDL treatment have shown response rates of 80-90%.13,14Given that PDL is characterized by selective absorption by hemoglobin, effective photothermolysis of vascular lesions can be achieved. Nevertheless, the maximum penetration depth of PDL is 0.75-1.2 mm.3140-50% of IH reaches the subcutaneous tissue and effective treatment of IH requires a deep-penetrating laser such as the Nd:YAG laser (1064 nm, 5-6 mm penetration depth). gender is emphasized.31,32Additionally, PDL converts oxyhemoglobin to methemoglobin, which can lead to clot formation.32Absorption of the Nd:YAG laser by methemoglobin and thrombus is a further advantage of this laser system.This allows for effective vascular disruption while sparing surrounding tissue32.
Two large studies have been published so far on the combination of PDL and ND:YAG laser for the treatment of IH. Saafan and Salah treated 25 of his IH patients in the head and neck area, 72% were completely healed and 16% had mild hyperpigmentation/loss of pigmentation, or “structural skin changes.” , with 12% reporting an inadequate response.32In a retrospective study by Alcántara-González and colleagues, all 22 patients benefited from PDL and Nd:YAG LP laser treatment regardless of the developmental stage of IH.31.
To our knowledge, this is the first published prospective data investigating the treatment of residual hemangiomas with Nd:YAG LP laser monotherapy. Of the 30 patients enrolled in our study, 28 patients had an excellent or favorable response. In addition to assessing treatment success by physicians, our study also surveyed parents about their satisfaction. These results suggest high efficacy with low side effect rates and are superior to those reported in PDL monotherapy studies.31.
In our study, all patients had minimal, self-resolving side effects 3 days after their last laser session. The skin was sagging, leaving one quarter with hypopigmented scars and mild hyperpigmentation or blistering. In other published studies, laser treatment was associated with few side effects.Only a minority of patients developed mild atrophy, ulceration or hyperpigmentation31,32.
Various cooling systems have been developed to protect the epidermis from heat damage.33Ice or cold water can also be used to cool the blood vessels in the upper dermis, but the laser’s effectiveness will be limited. Our laser treatments were performed in a Zimmer Cryo 6 cold air chiller machine. Cryo 6 lowers skin temperature faster, maintains a constant dosage throughout treatment, and protects the epidermis from skin burns. In addition, many local anesthetics contain sympathomimetics and vasoconstrictors, which can reduce the effectiveness of laser treatment, thus replacing the need for anesthesia.
Importantly, one treatment was not sufficient and better results were reported in patients who received two sessions. This was sufficient improvement in most patients with her 2 laser sessions of her Nd:YAG LP laser compared to her PDL monotherapy of her IH which usually required 5 or more sessions. is obtained.13Therefore, treatment with Nd:YAG LP lasers reduces the number of treatments required while ensuring adequate response.
Regarding factors influencing response rate, efficacy was not dependent on gender, age, or lesion depth, but was affected by laser spot size and number of sessions.
The lack of difference in response speed between deep and superficial IH can be explained by choosing a deep-penetrating laser wavelength (Nd:YAG laser 1064 nm). Larger spot size lasers were associated with better responses. The larger the spot size, the deeper the penetration. Comparison of Nd:YAG lasers with other laser systems.
In summary, Nd:YAG LP laser therapy (1064 nm) has been shown to be an effective and safe method for treating IH with only 1-2 sessions. Our results suggest that Nd:YAG LP laser may be recommended as a secondary treatment for residual IH after propranolol treatment, especially for her IH with a deep component.