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Laser treatment of acquired vascular lesions

The term telangiectasia refers to a dilated venule, capillary, or arteriole visible to the human eye and measuring 0.1–1.0 mm in diameter (1). Telangiectasias develop on the face secondary to genetic predisposition, chronic actinic damage, collagen vascular disorders, topical steroid application, and disorders of vascular regulation such as acne rosacea. Linear and “spider” telangiectasias develop on the legs, especially in women, beginning in the second to third decade due to multiple factors including genetic predisposition, gravity, pregnancy, and trauma. Papular telangiectasias are frequently seen as part of genetic syndromes, such as Osler–Weber–Rendu syndrome, and are also seen in collagen vascular disorders (2). Spider telangiectasias typically occur in school-age children, with most persisting into adulthood. They present a cosmetic concern as well as the propensity to bleed with minor trauma (1). The predominant presenting symptom of patients with facial telangiectasia is cosmetic disfigurement. Therefore effective treatment should be as free of adverse sequelae as possible. Traditional treatment modalities for superficial telangiectasias have included sclerotherapy, electrodesiccation, and more recently, laser therapy. Sclerotherapy remains the gold standard of treatment for telangiectasias of the lower extremities, and involves the injection of a chemical sclerosing agent into a vessel in order to cause damage to the vessel wall with subsequent fibrosis. Adverse sequelae include ulceration, scarring, hyperpigmentation, and telangiectatic matting. Facial telangiectasias are less responsive to sclerotherapy than those located on the leg and are additionally more prone to complications (1). Electrodesiccation is generally used in the treatment of smallcaliber facial vessels but has the potential to produce scarring due to its nonspecific thermal effect (3). In addition, electrodessiccation often results in incomplete lesional response or recurrence when used to treat larger caliber vessels. Theoretically lasers and intense pulsed light sources should provide certain advantages over traditional treatment methods (4).