TREATMENT GUIDE | treatment guide


Vascular and pigmented lesions


Ramtin Kassir and Shuang Lei discuss the range of treatment protocols available for vascular and pigmented lesions


face or body in a variety of shapes and sizes. Such conditions include rosacea, broken capillaries, facial spider veins, cherry angioma, and capillary haemangioma. Pigmented lesions result from an overproduction of melanin underneath the skin, which manifest as birthmarks, freckles, sunspots and moles.


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Laser treatments Laser treatment of cutaneous vascular and pigmented lesions has progressed significantly over the past 30 years. A number of laser systems have been developed based on the principles of selective photothermolysis, which works by emitting light of a particular wavelength absorbed only by the target chromophore (haemoglobin in the blood vessels and the melatonin in the pigmented lesions). Heat generated by the laser serves to constrict blood vessels and eliminate irregular discolouration over time. Lasers on the market are 532 nm (KTP), 535 nm, 585 mm, 595 nm (pulsed dye), 810–830 nm (diode), 1064 nm


ASCULAR LESIONS


are collections of large blood vessels located directly under the skin, which form visible red marks anywhere on the


(Nd:YAG), and 500–1200 nm, or intense pulsed non-coherent light (IPL). Longer wavelengths allow deeper penetration into the dermis and enable the destruction of larger vessels. An appropriate laser device should be selected based on the type and depth of the vascular or pigmented lesions.


Intense pulsed light IPL devices are unlike lasers because they emit a broad-spectrum light that effectively shrinks capillaries and reduces hyperpigmentation. In addition to treating uneven skin tone, IPL also induces the production of collagen and connective tissue, giving the skin a smoother feel and improving the appearance of wrinkles.


Treatment protocol Laser and IPL are outpatient procedures. Usually, one or two passes are performed over the affected area during each session. As the beam of light makes contact with the skin, patients may experience a tingling sensation, and a topical anaesthesia may be used per the patientÕs request. To appease the discomfort, a cooling treatment such as a transparent ultrasound gel


or a flow of cold air is applied over


the skin during treatment. Purpura and slight bumps may appear


April/May 2012 | prime-journal.com


over the treated area immediately after treatment, but should disappear within a few hours. Crusting, a rare adverse event, will also resolve within days. For the first 24–72 hours, the patient is recommended to avoid sun exposure, and sometimes physical activity. Otherwise, no downtime is required and normal activities can be resumed after light therapy. Noticeable results can be seen within


days. Vascular lesions will shrink and appear lighter, while pigmented lesions tend to darken and exfoliate away. Final results are evident within 3 weeks, at which point an additional round of treatment may be initiated at the physicianÕs discretion. Usually, 2–6 treatments will suffice, but depending on the severity of the lesions, more treatments may be necessary.


Regulation Lagging behind the growing popularity of these skin rejuvenation procedures is the notorious lack of regulation. Cosmetic lasers and IPL machines are powerful devices that can cause permanent skin damage and eye injuries, yet medical training is not required by New York State law for the manoeuvring of these highly risky machines, for example. Laser


Noticeable results can be seen


within days. Vascular lesions will shrink and appear lighter, while


pigmented lesions tend to darken and exfoliate away.


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