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Reviews the use of lasers in the treatment of superficial cutaneous vascular lesions, followed by details of the use of two types of yellow light lasers in Australia.
This report consists of a review of the ue of lasers in the treatment of superficial cutaneous vascular lesions, followed by details of the use of two types of yellow light lasers in Australia. A Candela pulsed dye laser was used at the Royal Prince Alfred Hospital, Sydney, and a Norseld copper bromide laser at Flinders Medical Centre, Adelaide.
Yellow light lasers are a relatively recent approach to the treatment of port wine stains and other superficial vascular lesions. They offer advantages over earlier methods in having fewer adverse effects, particularly scarring, and often giving more complete removal of the lesion, especially in children with light-coloured lesions.
Initial treatment involves checking the response of a small area of the lesion (a test patch) to the laser radiation. For patients with port wine stains, the Candela pulsed dye laser and the Norseld copper bromide laser gave similar results, with most responses being good or excellent.
For 23 patients with port wine stain whose treatment with the Candela laser was completed, excellent or good responses were obtained in 20, two had a fair response and one person had poor results. Incomplete treatment results on 45 patients treated with the Norseld laser suggested that that system would also be effective in treatment of port wine stain.
The Candela laser was also effective in treating a range of other conditions. Good or excellent results were obtained in the majority of patients treated for telangiectasia (46 of 48), spider naevi (25 of 26), rosacea (12 of 14) and other less common conditions (7 of 12).
Most patients at the Sydney unit were satisfied with the results of treatment, as judged by their responses on a seven-point scale indicating the degree of happiness with outcome. On some occasions, the patient's perception of the final outcome varied substantially from that of the operator.
Notional costs for a single 30-minute treatment session, excluding rental of premises, salary-related overheads and insurance, were estimated at $227 for the Candela pulsed dye laser and $110 for the Norseld copper bromide laser.
On the basis of experience at Royal Prince Alfred Hospital, the total cost of treating a port wine stain in an adult with the Candela laser might range from $687 to $1,832, depending on the size of the lesion and the number of sessions required. It was not possible to estimate the total cost of treating a port wine stain with a copper bromide laser from the data available from the Adelaide study.
Infrastructure requirements are modest for either type of laser if adults are being treated. Treatment of children usually requires a general anaesthetic which substantially increases the total cost.
Treatment with currently available lasers is slow. Treatment of an area of 20 cm2 takes about 10 minutes with the Candela or the Norseld devices. In most cases, patients will need to return for further treatment to achieve maximal fading, wit,h an interval of several weeks between treatment sessions.
At present, time to complete treatment with the Candela laser at the hospital is further increased because of limits to the number of clinics that can be offered. As a result, the waiting time for patients requiring follow-up treatment is substantially longer than appropriate.
With present technology, it is unlikely that any one machine will meet all the requirements of a dermatology department. Ideally, access to more than one laser type would be needed to optimise treatment for each patient.
Newer types of laser are becoming available which will offer the promise of reducing costs of treatment. When these are considered for acquisition, they should be critically assessed in terms of cost, speed of treatment, complications and patient outcomes.
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