Treatment of a venous-lake angioma with intense pulsed light
Authors: Harvey Jay, Carimia Borek
Journal: The Lancet (1998)

Venous-lake angiomas are dilated venules in the upper dermis that are lined by a layer of endothelial cells and a thin wall of fibrous tissue.1Goldman MP Fitzpatrick RE Treatment of cutaneous vascular lesions.in: Goldman MP Fitzpatrick RE Cutaneous laser surgery: the art and science of selective photothermolysis. Mosby-Year Book, St Louis1994: 92-104Google Scholar, 2Tan TO Kurban AK Non congenital benign cutaneous lesions: pulse dye laser treatment.in: Tan OT Management and treatment of benign cutaneous vascular lesions. Lea & Febiger, Philadelphia1992: 163-164Google Scholar, 3Neuman RA Knobler RM Venous lakes (Bean-Walsh) of the lips—treatment experience with the argon laser and 18 months follow-up.Clin Exp Dermatol. 1990; 15: 115-118Crossref PubMed Scopus (39) Google Scholar They appear as tender dark blue nodules and are usually seen on the lips and ears of older people.1Goldman MP Fitzpatrick RE Treatment of cutaneous vascular lesions.in: Goldman MP Fitzpatrick RE Cutaneous laser surgery: the art and science of selective photothermolysis. Mosby-Year Book, St Louis1994: 92-104Google Scholar, 2Tan TO Kurban AK Non congenital benign cutaneous lesions: pulse dye laser treatment.in: Tan OT Management and treatment of benign cutaneous vascular lesions. Lea & Febiger, Philadelphia1992: 163-164Google Scholar Treatment is for cosmetic reasons or because of recurrent bleeding. Treatment of venous lakes by excision, cryosurgery, or electrocoagulation has been complicated by bleeding, swelling, and pain.3Neuman RA Knobler RM Venous lakes (Bean-Walsh) of the lips—treatment experience with the argon laser and 18 months follow-up.Clin Exp Dermatol. 1990; 15: 115-118Crossref PubMed Scopus (39) Google Scholar Treatment with the argon laser1Goldman MP Fitzpatrick RE Treatment of cutaneous vascular lesions.in: Goldman MP Fitzpatrick RE Cutaneous laser surgery: the art and science of selective photothermolysis. Mosby-Year Book, St Louis1994: 92-104Google Scholar, 3Neuman RA Knobler RM Venous lakes (Bean-Walsh) of the lips—treatment experience with the argon laser and 18 months follow-up.Clin Exp Dermatol. 1990; 15: 115-118Crossref PubMed Scopus (39) Google Scholar may leave scars, and the flashlamp-pulsed-dye laser1Goldman MP Fitzpatrick RE Treatment of cutaneous vascular lesions.in: Goldman MP Fitzpatrick RE Cutaneous laser surgery: the art and science of selective photothermolysis. Mosby-Year Book, St Louis1994: 92-104Google Scholar, 2Tan TO Kurban AK Non congenital benign cutaneous lesions: pulse dye laser treatment.in: Tan OT Management and treatment of benign cutaneous vascular lesions. Lea & Febiger, Philadelphia1992: 163-164Google Scholar produces purpura lasting several weeks. A new intense pulsed light source (IPL), the PhotoDerm VL (ESC Medical Systems, Yokneam, Israel),4Goldman MP Eckhouse S ESCMedical Systems Ltd. Photoderm VL Cooperative Study Group. Photothermal sclerosis of leg veins.Dermatol Surg. 1996; 22: 323-330Crossref PubMed Scopus (142) Google Scholar characterised by a broad spectrum and a longer variable pulse duration, is effective in the treatment of various vascular lesions with minimal side-effects.4Goldman MP Eckhouse S ESCMedical Systems Ltd. Photoderm VL Cooperative Study Group. Photothermal sclerosis of leg veins.Dermatol Surg. 1996; 22: 323-330Crossref PubMed Scopus (142) Google Scholar A pulse width is chosen to deliver light energy within the thermal relaxation time (cooling time) of the target vessels.4Goldman MP Eckhouse S ESCMedical Systems Ltd. Photoderm VL Cooperative Study Group. Photothermal sclerosis of leg veins.Dermatol Surg. 1996; 22: 323-330Crossref PubMed Scopus (142) Google Scholar, 5Anderson RR Parrish JA Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation.Science. 1983; 220: 524-527Crossref PubMed Scopus (2851) Google Scholar The large spot size (8·35 mm) allows deeper photon penetration.4Goldman MP Eckhouse S ESCMedical Systems Ltd. Photoderm VL Cooperative Study Group. Photothermal sclerosis of leg veins.Dermatol Surg. 1996; 22: 323-330Crossref PubMed Scopus (142) Google Scholar We report treatment of a venous-lake angioma with the PhotoDerm VL IPL. The treated lesion was 11 mm in diameter and 4 mm deep on the right upper lip of a 70-year-old woman (figure, top), and had been present for over 3 years. A cool thermocoupling gel, BVL (ESC Medical Systems),4Goldman MP Eckhouse S ESCMedical Systems Ltd. Photoderm VL Cooperative Study Group. Photothermal sclerosis of leg veins.Dermatol Surg. 1996; 22: 323-330Crossref PubMed Scopus (142) Google Scholar was applied to the area of the venous lake before treatment. We used wavelengths above 590 nm, a triple pulse mode4Goldman MP Eckhouse S ESCMedical Systems Ltd. Photoderm VL Cooperative Study Group. Photothermal sclerosis of leg veins.Dermatol Surg. 1996; 22: 323-330Crossref PubMed Scopus (142) Google Scholar delivering an average fluence of 67·5 J/cm2Tan TO Kurban AK Non congenital benign cutaneous lesions: pulse dye laser treatment.in: Tan OT Management and treatment of benign cutaneous vascular lesions. Lea & Febiger, Philadelphia1992: 163-164Google Scholar in three consecutive pulses, separated by an average 50 ms delay, with an average 5·1 ms duration per pulse. Six such triple pulses were delivered to the lesion during one treatment session. No anaesthesia was required. The lesion lightened immediately after treatment, with no purpura. 33 days after treatment the area was normal in appearance and to palpation (figure, bottom).