title: Pulsed dye laser treatment of capillary malformations in infants at 2-weekly versus 3-monthly intervals, reducing the need for general anaesthesia.
abstract: Capillary malformations (CM) cause significant psychosocial complications. Pulsed dye laser (PDL) treatment at 6-12-weekly intervals under general anaesthesia (GA) commencing in infants at 6 months of age remains the standard of care in order to achieve maximal improvement prior to school age. The safety of repeated GA in children is controversial. Shortening the time between treatments increases the number that can be delivered prior to 6 months of age, thus reducing the number of subsequent treatments needed under GA. We investigated the safety and effectiveness of more frequent PDL treatment of CM in infancy via a pilot, prospective patient-controlled study of 10 patients. Using 595 nm (Vbeam) PDL, the entire CM was treated initially, then half the CM randomly allocated to 2-weekly and half to 3-monthly intervals for two further treatments. Photographs of the CM taken 3 months after treatment completion were evaluated by an independent, blinded dermatologist. Nine infants completed the study. Three infants (33%) had more improvement on the 2-weekly treated side and four (44%) had more improvement on the 3-monthly treated side. Two patients (22%) showed no difference between sides. Treatments were well tolerated without complications. We conclude that 2-weekly PDL treatments of CM in infants aged under 6 months is effective and well tolerated without adverse effects. Our preliminary data suggest a possible superior efficacy with 3-monthly treatment intervals; however, larger studies are warranted for stronger evidence. More frequent non-GA treatment of CM in infants should be further investigated to decrease the risk of repeated GA exposure in young children.
authors.affiliation: Laser Unit, Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Bonnie C
authors.initials: BC
authors.lastname: Swan
authors.affiliation: Laser Unit, Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Robertson
authors.affiliation: Laser Unit, Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Alana
authors.initials: A
authors.lastname: Tuxen
authors.affiliation: Laser Unit, Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Ellen
authors.initials: E
authors.lastname: Ma
authors.affiliation: Laser Unit, Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Leona
authors.initials: L
authors.lastname: Yip
authors.affiliation: Laser Unit, Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Lena
authors.initials: L
authors.lastname: Ly
authors.affiliation: Laser Unit, Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Bingham
authors.affiliation: Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davidson
authors.affiliation: Laser Unit, Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Philip
authors.identifier: http://orcid.org/0000-0001-7015-0221
authors.initials: P
authors.lastname: Bekhor
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D054025:Lasers, Dye / Q000009:adverse effects / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D010865:Pilot Projects; D019339:Port-Wine Stain / Q000532:radiotherapy*; D011446:Prospective Studies; D013997:Time Factors
keywords: capillary malformation; laser treatment; port wine stain