Hemangiomas are the most common benign tumor of infancy,and at least 60% occur in the head and neck region. Although an estimated 70% of hemangiomas regress satisfactorily, 30% of patients have cosmetically significant deformities.Parents eagerly seek treatment options on a proactive
basis, and the laser is a potentially useful option in several settings. The pulsed yellow dye laser may be useful for very early hemangiomas, ulcerated hemangiomas, and regressed he-
TABLE 2 0 . 2
CLINICALLY USEFUL LASERS AND OTHER
PHOTOTHERAPY DEVICES
Vascular lesions Yellow dye
KTP
Nd:YAG
Copper vapor
Intense pulsed light
Skin resurfacing Carbon dioxide
Erbium:YAG
Radiofrequency
Benign lesions, pigmented Intense pulsed light
Diode
Ruby
Benign lesions, cutaneous Carbon dioxide
Hair removal Alexandrite
Diode
Neodymium:YAG
Ruby
Intense pulsed light
Tattoo removal Ruby
Alexandrite
Neodymium:YAG
mangiomas that still contain vascular pigmentation or visible, ectatic vessels. The laser only penetrates about 1 mm into the skin, making it most effective for small, flat hemangiomas. Parents should be advised that multiple laser treatments may be necessary every 2 to 4 weeks, as hemangiomas often exhibit temporary regression followed by rebound growth. Laser therapy
can be discontinued when the hemangioma finally enters a permanent state of regression. Topical application of anesthetic cream may be desirable to reduce both patient and parent discomfort. Laser treatments are ineffective for already bulky or subcutaneous hemangiomas, as the light will not penetrate deeply enough to produce a noticeable improvement. Ulcerated hemangiomas can be excruciatingly painful, especially when located in the perineal region. There has been some success with pulsed yellow dye laser treatment of these hemangiomas,with some babies showing significant pain relief within 24 to 48 hours, probably as a result of coagulation of the sensitive nerve endings within the wound. Faster healing has also been reported, although the mechanism for this observation is unclear. Perhaps the laser induces some regression of the hemangioma,or wound care is facilitated once the area becomes less sensitive, allowing for more rapid re-epithelialization. Lastly, hemangiomas that have regressed well enough to avoid the need for surgical excision may have residual ecstatic vessels that will improve with pulsed dye laser therapy (Fig. 20.2). Larger telangiectasias may also respond to simultaneous sclerotherapy and laser treatment. Endothelial injury from the sclerosant followed by laser photocoagulation of the vessels may have a synergistic benefit in removing these residual vessels.