Treatment of molluscum contagiosum with 585 nm collagen remodeling pulsed dye laser.

The inevitable regression of molluscum contagiosum (MC) has been the major argument in favor of leaving the lesions to spontaneous involution. But the infection is often widespread and recurrent. Conventional therapies are frequently ineffective and require multiple visits. Flashlamp-pumped pulsed dye laser is now recommended in the therapy of MC in case reports. There is no evaluation of a pulsed dye laser collagen remodeling (wavelength of 585 nm) as a possible therapeutic alternative. We treated 76 patients with cutaneous MC with 1 to 176 MC (mean 27 MC) in a prospective study from April 2002 to September 2002 (over a period of six months). The female/male sex ratio was of 1.2:1 (42 girls, and 34 boys). Patients were aged from 1 to 15 years, with a mean of 4.9 years. We used 585 nm collagen remodeling, double flashlamp excited pumped dye laser ED2000 (manufactured by Deka(c) MELA Calenzano, Italy), spot size 5 mm, energy density (fluence J/cm(2)) from 2 to 4 J/cm(2), emission modality (repetition rate) at 0.5 Hz, with a short pulse duration of 250 microsec in all cases. The therapy was well tolerated. No scars or pigment anomalies were observed. 96.3% of the lesions healed after the first treatment, the remaining 3.7% after the second (two weeks later). Laser photocoagulation causes selective damage to abnormal vessels and surrounding connective tissue. The heating effect in these skin layers triggers the release of various growth factors that stimulate collagen remodeling and tightening. It appears to be a cell-mediated reaction, which brings about an elevation in the T lymphocytes, capable of affecting pox viridae. Dye laser photocoagulation however, cannot protect against relapse. Hyperpigmentation may occur at nearly all sites, however this fades after 1 to 6 months. The pulsed dye laser for collagen remodeling is an effective, bloodless, quick, and easy therapeutic alternative for MC. The advantage of using a collagen remodeling pumped dye laser is the absence of pain, because of the short pulse duration (half that of a normal pulsed dye laser), and the use of low fluence (less than 4 J/cm(2)). It enables the treatment of young patients with a large number of lesions, which is impossible with a normal pulsed dye laser. There are no side effects.