Hohenleutner U, Walther T, Wenig M, Bäumler W, Landthaler M
Department of Dermatology, University of Regensburg, Germany.
Lasers Surg Med. 1998;23(2):72-8. doi: 10.1002/(sici)1096-9101(1998)23:2<72::aid-lsm4>3.0.co;2-s.
Preliminary results indicate that pulsed dye lasers (PDL) with 1.5 ms pulsewidth and 595 nm wavelength are effective in the treatment of leg telangiectasia. The aim of this study was to evaluate if the clinical results could be improved by a) an effective skin cooling with ice cubes and b) the longer wavelength of 600 nm.
STUDY DESIGN/MATERIALS AND METHODS: In 87 patients with vessels up to 1 mm in diameter, 257 single test treatments were performed using wavelengths of 595 and 600 nm, fluences of 16, 18, and 20 J/cm2, a 1.5 ms pulse duration, and an elliptical spot of 2 x 7 mm. In 7 patients, the skin surface temperature curve was measured after cooling with ice cubes vs hydrogel dressings, and spot geometry and fluence were investigated with and without the gel dressing.
Vessel clearance was evaluated 6-8 weeks after treatment. 20 J/cm2 were most effective (80% clearance >50%), and 18 J/cm2 were more effective than 16 J/cm2 (66.2 vs 52.5% clearance >50%). There was a tendency towards better results with 595 nm, but the differences were not significant. Vessels with a diameter <0.5 mm cleared significantly better than those with 0.5-1 mm (69.1 vs 31.9% clearance >50%). Hypo- and hyperpigmentation were seen in 32% of the patients. Cooling with ice cubes proved to be far more effective than with hydrogel dressings (temperature decrease approx 15 vs 5 degrees C). Additionally, the gel dressing caused an energy loss of approx 35% and an irregular spot geometry as shown on burn paper.
Treatment of leg telangiectasia with the 1.5 ms-PDL is safe and effective, especially in vessels smaller than 0.5 mm in diameter; 595 nm and 18 J/cm2 seem to be somewhat more effective as 600 nm and 16 J/cm2; and 20 J/cm2 are even more effective, but persistent hyperpigmentation cannot yet be excluded due to insufficient follow-up time. Cooling with ice cubes is more effective and less expensive than gel dressings, and the short term clinical results are equivalent, even if the frequency of transient pigmentary changes is increased.
初步结果表明，脉宽为1.5毫秒、波长为595纳米的脉冲染料激光在治疗腿部毛细血管扩张方面有效。本研究的目的是评估是否可以通过以下方式改善临床效果：a）用冰块进行有效的皮肤冷却；b）采用600纳米的更长波长。
研究设计/材料与方法：对87例直径达1毫米的血管患者进行了257次单次测试治疗，使用的波长为595和600纳米，能量密度为16、18和20焦/平方厘米，脉冲持续时间为1.5毫秒，光斑为2×7毫米的椭圆形。对7例患者，在用冰块冷却与用水凝胶敷料冷却后测量皮肤表面温度曲线，并研究有无凝胶敷料时的光斑几何形状和能量密度。
治疗后6至8周评估血管清除情况。20焦/平方厘米最为有效（清除率>50%的达80%），18焦/平方厘米比16焦/平方厘米更有效（清除率>50%分别为66.2%和52.5%）。595纳米似乎有取得更好效果的趋势，但差异不显著。直径<0.5毫米的血管清除情况明显优于直径为0.5 - 1毫米的血管（清除率>50%分别为69.1%和31.9%）。32%的患者出现色素减退和色素沉着。事实证明，用冰块冷却比用水凝胶敷料冷却有效得多（温度降低约15摄氏度对5摄氏度）。此外，凝胶敷料导致能量损失约35%，且如在烫纸上所示光斑几何形状不规则。
用1.5毫秒脉冲染料激光治疗腿部毛细血管扩张是安全有效的，尤其对于直径小于0.5毫米的血管；595纳米和18焦/平方厘米似乎比600纳米和16焦/平方厘米稍有效；20焦/平方厘米甚至更有效，但由于随访时间不足，尚不能排除持续性色素沉着。用冰块冷却比凝胶敷料更有效且成本更低，即使短暂色素变化的频率增加，短期临床结果也是相当的。
