Early Combined Laser Treatment of Strawberry Hemangiomas using Pulsed Dye Laser and Nd-YAG Laser

Abstract

Since strawberry hemangiomas (SH) involute spontaneously by 5 to 6 years of age, wait and see policy is usually indicated. But SH are not completely regressed leaving capillary dilatations and subcutaneous tumors actually in almost all cases. Especially remained atrophic skin surfaces and fine wrinkles are not able to be repaired completely by surgical techniques. To prevent these secondary deformities we proposed early-stage laser treatment with pulsed dye laser and Nd-YAG laser within a suckling age.We started to treat as soon as the SH could be fined out. The earliest case was 6 weeks after birth. The purpose of this study was to investigate the of of the early laser treatment for SH in infants. The SH are devided into capillary hemangiomas (CPH) and cavernous hemangiomas (CVH); CPH are mainly located in the dermis, and CVH are in the subdermis. CPH were treated with the pulsed dye laser (585nm, 450μsec), and CVH were treated with the CW Nd-YAG laser. CW Nd-YAG laser was irradiated by two methods according to volume of the CVH lesions,which are transcutaneous irradiation for slightly elevated SH and percutaneous bare-fiber insertion for markedly elevated SH. Ulcerated hemangiomas were treated by low reactive level laser therapy (LLLT) using Nd-YAG laser. Consequently the early treated SH using combined laser therapy were involuted promptly as compared with the naturally regressed SH without any secondary marked deformities. Further we emphasize the need of ultra-early laser therapy of SH starting within 4 weeks neonate before proliferative growth phase, since markedly enlarged SH can not involute completely.