Child with erythematous non blanching bosselated lesion on right side of face, Rx is:
C i.e. Flash light pumped dye laser Flash lamp pumped - pulsed tuneable dye lasers (PDL)Q is the intervention of choice for uncomplicated porwine stains (PWS) or capillary malformations (CM). 1st generation PDLs operated at 577 or 585nm and achieve lightening by reducing number and size of erythrocytes in vessels by selective photothermolysis (as oxyhemoglobin has absorption peak at 577/542/ and 418nm). Flash lamp-pumped PDL uses a high-power Xenon flashlamp to excite rhodamine(organic) dye to produce a pulse of yellow light that is absorbed by oxyhemoglobin. Pulsed lasers allowed for more precise targeting of oxyhemoglobin containing vessels with less thermal and mechanical injury of surrounding tissue. Because of emission of continuous thermal energy 1/t scarring and pigmentary alteration, the use of early lasers such as argon laser (488/514nm), argon pumped tunable laser (488 to 638nm), copper and bromide laser (578nm), potassium -titanyl-phosphate (KTP) laser (532 nm) and krypton laser (568nm) is limited. 585nm sho pulse PDL is probably optimal for treating paediatric PWS because vessel diameters are relatively small. Success rate is 50-90%; the size of vessels, its depth and density will influence the response. Factors oring a good response to PDL are presence of more superficially located vessels, flat and red/scarlet (as opposed to pink and purple) PWS on head and neck (a compared to other body sites), as well as youth. Although peripheral facial lesions respond better than midline-centrofacial or cheeks. Side effects of PDL are few and includes bruising (in all cases), pain, swelling, crusting bleeding, pyogenic granuloma, both hypo and hyper-pigmentation, pial re-emergence and redarkening. 2nd generation PDLs, emit light with a longer wave length of 595nm (absorption of which by Hb02 is 5 times lower), longer pulse width, higher flUences with addition of cooling system. This may be suitable for deeper, bigger vessels in resistant or adult PWS. In PDL resistant capillary malformations KTP laser may produce extra lightening. Hyperophic and PDL resistant PWS are sometimes treated with near infrared lasers such as alexandrite (755nm) and Nd: YAG (1064nm) laser, multiple pass irradiation with two PDL passes:1st at 590-600nm and 2nd at 585nm, and intense pulsed light (e.g. photoderm) or combined pulsed dye & Nd:YAG laser. Other possibilities under investigation include electro-optical synergy and vaccum assisted laser treatment. Adult patients in whom progressive vascular ectasia has resulted in very exophytic lesions are probably best treated with CO2 laser.
Erbium laser
Nd-YAG laser
Flash light pumped dye laser
Q ruby laser