Successful Treatment of Lower Extremity Telangiectasias Using 585-nm Pulsed-Dye Laser at Low Fluence Combined With Optical Coherence Tomography: A Case Report

November 2019 | Volume 18 | Issue 11 | Case Reports | 1180 | Copyright © November 2019

li Rajabi-Estarabadi MD, Caiwei Zheng BA, Natalie Williams BS, Samuel C. Smith MS, Keyvan Nouri MD, Robert S. Kirsner MD PhD

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL

Abstract
Background: Significant advances have been made in using lasers and intense pulse light sources to treat common vascular lesions such as telangiectasias. However, the treatment of leg telangiectasia, specifically, is more challenging because it involves the clearing of smaller veins as well as the larger feeding veins. The latest guidelines recommend use of short wavelength pulse-dyed lasers (PDL) as an option to treat telangiectasia cases that are unresponsive to sclerotherapy.

Methods: A 29-year-old white woman presented with persistent telangiectasia, with multiple telangiectasias ranging from 1 cm to 20 cm in size involving the dorsal feet and both ankles and legs, which developed 10 years prior, associated with paresthesia. Test spots were treated with a 585-nm pulsed dye laser with various energy settings, and treatment was performed at 5.5 J/cm2 with spot size 10 mm and 0.5ms pulse duration.

Results: Near complete clearance was achieved 1 month after the single treatment without adverse effects. Optical coherence tomography (OCT) imaging demonstrated a reduction of cutaneous blood flow after treatment.

Discussion: We report successful treatment despite using settings that were previously reported to lack efficacy. This treatment resulted in considerable improvement in aesthetics and symptomatology. Also, OCT confirmed decreased vascular flow and bulging.

Conclusion: Our results suggest there is still much to learn about the use of PDL in treating telangiectasias of the lower extremities, and that the ideal parameters warrant further investigation. Moreover, the novel use of OCT in auxiliary imaging for identification of treatment spots, as well as monitoring response at a microvascular level, holds great potential for wider application.

J Drugs Dermatol. 2019;18(11):1180-1182.

INTRODUCTION

Telangiectasias of the lower extremities are common. Sclerotherapy is the first-line treatment for telangiectasias, but significant advances have been made in using lasers to treat these vascular lesions,1,2 including use of pulsed dye laser (PDL), potassium-titanyl-phosphate (KTP)-lasers, and longer wavelength lasers such as alexandrite lasers, diode lasers (800 nm – 900 nm), and millisecond Nd:YAG lasers (1064 nm). Among these, short wavelength PDL has been viewed as a subpar treatment option for telangiectasia. There is also a perhaps unfounded consensus that longer wavelength PDL with higher fluences is better suited for treating vascular lesions of the lower extremities due to the vessels’ deeper location and larger diameter, respectively.3

In this report, we investigate the use of short wavelength PDL with low fluence levels in treating a patient with telangiectasia of the lower extremities that did not respond favorably to sclerotherapy. Additionally, we employed optical coherence tomography (OCT) imaging to identify the treatment area and monitor treatment response at the microvascular level. We report successful treatment of lower extremity telangiectasia with a single session of 585-nm PDL therapy at low fluences in combination with OCT monitoring, which resulted in considerable improvement in aesthetics and symptomatology.

Case Presentation
A 29-year-old Caucasian woman (Fitzpatrick skin type I) presented with multiple telangiectasias ranging from 1 cm to 20 cm in size, involving the dorsal feet and both dorsal and ventral ankles and legs, which developed 10 years prior, associated with paresthesia. Two biopsies favored the diagnosis of essential telangiectasia. The patient had been previously treated with sclerotherapy, along with gabapentin 200mg nightly for paresthesias of the affected areas; but both provided only limited improvement. She had noted frequent nosebleeds since childhood, but otherwise had no history of weight loss, fatigue, gastrointestinal bleeding, or neurological symptoms. No family history of similar symptoms was reported.