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.
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.
