Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of patients with severe depigmentation.
BACKGROUND
Pulsed dye laser (PDL) treatment is widely used for poikiloderma of Civatte. Some adverse events in small numbers of patients have been reported. Guidelines for treatment of poikiloderma of Civatte do not exist.


OBJECTIVE
To report the occurrence of persistent depigmentation as a late adverse event in a series of patients with poikiloderma of Civatte after treatment with PDL.


METHODS
Eight patients (seven women and one man, mean age 48 years) with poikiloderma of Civatte were treated with PDL using a 585-nm wavelength and a fixed pulse duration of 450 micros. In all patients one or two test PDL patches were performed and reviewed after 3 months. All of the patients tolerated the testing without complications. Subsequent treatments were undertaken at intervals of 3 months.


RESULTS
All patients were treated with fluences between 3.5 and 7 J/cm2, using a 7- or 10-mm spot size. All patients had a good result with respect to clearing of the vascular component. Nevertheless, six of them, treated with 5-7 J/cm2, reported severe depigmentation 4-11 months after treatment. Two patients treated with lower fluences (3.5-5.5 J/cm2) did not report this depigmentation.


CONCLUSIONS
Great care is needed when PDL treatment is used for poikiloderma of Civatte. Pigment changes have been incidentally mentioned as late complications but have not been well documented as the late depigmentation has been in this series. It is advisable to use fluences as low as possible, and not exceeding an upper limit of 5 J/cm2, on a 10-mm spot size. More research is needed to define an optimal pulse duration.
Meijs
M M
MM
Department of Dermatology and Venereology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands. m.m.meijs@amc.uva.nl
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D000328:Adult; D004396:Coloring Agents; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000532:radiotherapy*; D017496:Hypopigmentation / Q000209:etiology*; D028022:Low-Level Light Therapy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010787:Photosensitivity Disorders / Q000532:radiotherapy*; D012720:Severity of Illness Index; D012880:Skin Pigmentation / Q000528:radiation effects*
D004396:Coloring Agents