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    Differentiating and treating vascular lesions in kids


    Cautions around PDL

    Clinicians using the PDL to treat port wine stains should be aware that findings of a recent survey raise concern about the risk of long-term alopecia when treatment is delivered to hair-bearing sites in very young children. Of the respondents who had used the PDL to treat port wine stains of the eyebrow and/or scalp, about one-fourth reported having at least one patient develop long-term alopecia (no sign of hair regrowth after several years of nontreatment). The overall incidence in the surveyed population was 1.5% to 2.6%. 

    “It is thought the alopecia can occur even if the laser settings are correct because the relatively thin skin in early infancy may leave the hair bulbs more vulnerable,” Dr. Friedlander added. 

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    For treatment of recalcitrant or recurrent port wine stains, there is evidence to show that use of lasers with a longer wavelength, either a 755 nm alexandrite or 1064 nm Nd:YAG, can be helpful. There are also data showing that using adjunctive topical imiquimod or rapamycin can improve the response to PDL treatment.

    At the same time, however, it is important to be sure that the treatment failure is not due to misdiagnosis. In that regard, Dr. Friedlander presented one case of a child with an early segmental hemangioma and others with morphea that were initially misdiagnosed as a port wine stain and treated with the PDL.

    “The child with hemangioma did not get proper systemic treatment early on, and for a child with morphea, treatment requires a systemic corticosteroid and perhaps methotrexate,” she said.  “It is crucial to be certain of your diagnosis before embarking on laser therapy.”





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