Laser Treatment For Vascular Birthmarks - What To Expect ?
Some birthmarks can now be removed by laser treatment. There are different types of vascular birthmarks each with different prognosis. You should consult your doctor for advice if you wish to seek treatment.
|Portwine stain Fig.1 & 2
Fig. 1 Portwine stain - A birthmark which tends to be permanent.
Fig. 2 If left untreated, portwine stains can become darker and develop lumps causing disfigurement.
This is a blood vessel abnormality affecting up to 0.5% of the population. It looks like a pink patch at birth and will not go away. Instead as one grows older the birthmark will steadily darken and becomes larger. By midlife, many of those afflicted with the condition may suffer cosmetic disfigurement, which can occur on any part of the body. If the birthmark becomes too large or thick it may bleed.
|Strawberry haemangiomas Fig. 3
Fig. 3 Strawberry haemangioma in an infant
These are overgrown or enlarged blood vessels which unlike portwine stain grow very rapidly after birth but often fade away with time. Such birthmark usually resolves by 5-6 years of age. Some haemangioma may occur near the mouth or eyes and may interfere with eating or vision and should be treated early before complications set in. (Sometimes the haemangioma may bleed or become infected). You should consult your doctor if the haemangioma enlarges rapidly or bleeds profusely. Urgent treatment may be necessary.
|Spider veins Fig.4
Fig. 4 Spider naevi - Dilated blood vessels
Like strawberry haemangiomas, spider veins are overgrown or enlarged blood vessels on the skin. They contain a central large blood vessel with tiny vessels radiating from the centre, hence the name. They usually do not cause problems except that they look unsightly. Spider veins may sometime be associated with an underlying chronic liver disorder. You should consult your doctor for investigations.
Q. Why should I have my birthmarks treated ?
A. Many people are uncomfortable with unsightly birthmarks. Young children or infants can be treated before they are subject to the psychological and physical blemishes that may be associated with the birthmarks. Sometimes birthmarks may bleed, become infected or interfere with vision, eating or other bodily activities.
Vascular birthmarks tend to enlarge together with body size. The total treatment area is smaller when treated early. It is generally cheaper to treat small lesions.
Q. How safe is the treatment ?
A. The flashlamp pulsed dye laser is able to selectively treat the blood vessels of vascular birthmarks without adversely affecting the surrounding skin tissues. It can eliminate many lesions while leaving the surrounding skin and skin pigment intact, thus reducing scarring. This treatment is safe to be used on infants as young as a few weeks old.
Q. What does treatment with the flashlamp pulsed dye laser consist ?
A. The laser treatment varies from patient to patient depending on the type of vascular birthmark, size and location of the affected area, the colour of the skin and the depth to which the abnormal vessels extend beneath the skin's surface.
The steps involved are
- The doctor will test your skin reaction to the laser during your first visit to determine the most effective treatment dose.
- Because the laser operates at a wavelength that is potentially harmful to the eyes, you will be asked to wear a special goggles with opaque lens or coloured lens.
- Treatment consists of placing a small handpiece or "wand" against the surface of the skin and activating the laser. The flashlamp pulsed dye laser will strike the skin in an intermittent fashion. Each pulse feels, for a small fraction of a second, like the snapping of a small rubber band against your skin.
- Small birthmarks, like spider veins, will require only a few pulses, while others, like portwine stains, will require many more. Larger birthmarks will require retreatment, necessitating multiple patient visits.
Q. Is the laser treatment painful ?
A. Most adults tolerate treatment without the need for anaesthesia, although treatment of larger lesions may be less comfortable. Your doctor will prescribe you a topical anaesthetic cream which you should apply under occlusion one hour before the laser surgery. The cream will help to reduce the pain during laser treatment.
Children, particularly infants, may have a lower pain threshold and may tolerate the procedure better with the use of sedatives or anaesthesia.
Q. What is the skin reaction after laser treatment ?
A. Immediately after treatment, the skin on the lased area will turn dark-grey or appeared bruised. This will remain for up to two weeks until the dead blood cells are removed by special cells in your skin.
Occasionally, a very thin scab will form on the surface of the skin. This will fall off within two weeks.
In the first several hours after treatment, the lased area may feel hot, like a sunburn. You may relieve the discomfort by applying a cool cloth soaked in ice-cold water, or you can use a cloth wrapped around ice cubes or an ice pack.
During the next three to four days after laser treatment:
- avoid hot water on the treated skin
- avoid hot environment e.g. in sauna, spa
- you can wash the treated skin with tepid water but avoid soaps and rubbing or friction on the skin
- avoid or minimize sun exposure
- you may use moisturiser on the face if it is applied gently and not rubbed in
After the first four days, you may use a sunscreen if you are going outdoor. It is very important that you avoid excessive sun exposure for the first 3 months. Otherwise, a brownish pigmentation may occur which would take a few months to fade.
Q. What other information should I know ?
A. Optimal results will be achieved with the flashlamp pulsed dye laser only if you are not sun tanned. It is also recommended that you avoid exposing the treated area to the sun and to cover the area with a sun block that is prescribed by your doctor. Of course, this area may be exposed to the sun when you have completed the whole course of treatment.
Most patients will achieve at least 75% reduction in the redness. The skin colour of most patients do not blend completely with the normal skin. However, most patients after completion of the laser treatment will require only little or no camouflage cosmetics
Patients with tanned or darker skin types may have less favourable results with this form of laser treatment.
At the National Skin Centre, the cost per treatment ranges from S$200 to S$2,500 depending on the size of the area treated. Most patients will require about four to six treatment sessions to obtain optimal results.
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By National Skin Centre (Singapore)
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