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Laser treatment of connective tissue tube-shaped structure lesions has progressed considerably over the past twenty years. supported the pioneering work of Anderson and Maxfield Frederick Parrish within the early Eighties, many vascular-specific optical device systems are developed victimisation principles of selective photothermolysis.

Laser irradiation will by selection destroy specific targets (chromophores) among the skin by victimisation AN acceptable wavelength and pulse period. Pulse period should be but or capable the targeted thermal time constant of the radical, ie, the time necessary for the target to chill by 1/2 its peak temperature when optical device irradiation. as a result of the energy deposited within the tissue is proscribed to targeted sites, vital thermal diffusion to adjacent skin is prevented. additionally, as a result of wavelengths adore absorption peaks for varied skin chromophores area unit acknowledged, absorption of optical device energy is localized while not damaging neighboring structures. The targeted radical for tube-shaped structure lesions is intravascular oxyhemoglobin; so, thermal injury is basically restricted to connective tissue blood vessels.

Early optical device technology used continuous-wave (CW) mode lasers for treating connective tissue tube-shaped structure lesions. These lasers didn't prohibit injury to the targeted tube-shaped structure structures, and, consequently, their use resulted in an exceedingly high prevalence of scarring. periodical optical device systems, like the 585-nm periodical dye optical device (PDL), afterward were developed and became the mainstays of medical aid for each innate and purchased tube-shaped structure lesions. These lasers provide glorious clinical improvement with a coffee risk of adverse sequelae. Transient blood disorder is that the commonest adverse result of poundal treatment. Current technologic enhancements embrace dynamic surface cooling and extended pulse period, that enhance clinical results and minimize adverse effects.

CLASSIFICATION OF connective tissue tube-shaped structure LESIONS
Cutaneous tube-shaped structure lesions area unit classified in keeping with mode and age of onset. innate lesions begin in infancy and embrace port-wine stains, hemangiomas, blood vessel malformations, and lymphangiomas. innate lesions area unit found most typically on the top or neck and should be isolated or found as a part of a innate syndrome like Sturge-Weber syndrome. noninheritable  lesions develop in persons of any age and embrace telangiectasias, cherry angiomas, pathology granulomas, blood vessel lakes, poikiloderma, and Kaposi malignant neoplastic disease. noninheritable  lesions might occur ad lib, or they will be caused by trauma, ultraviolet exposure, or secretion changes.

Congenital lesions:

Port-wine stains

Port-wine stains, additionally called nevus or capillary malformations, area unit gift at birth and occur equally in each sexes. The prevalence rate within the general population is zero.3-0.5%. Lesions tend to grow with the patient, while not a bent towards regression. they're typically set on the face, and also the V2 surgical instrument is affected most typically. at first showing as light-pink macules, port-wine stains will darken over time as a results of progressive vessel ectasis. superjacent soft tissue or bony hypertrophy could also be related to these lesions. Use of the poundal is that the most popular treatment owing to its superior efficaciousness and low prevalence of adverse effects.

Hemangiomas

Hemangiomas area unit benign proliferations of blood vessels occurring in one0-12% of all youngsters by age 1 year. just one third of hemangiomas area unit gift at birth, and most area unit solitary lesions that occur on the top or neck. They generally bear a rapid climb part before involuting when AN undetermined quantity of your time. though some involution typically begins by the top of the primary year, several hemangiomas don't fully involute till the kid is aged 10-12 years.

Associated complications embrace ulceration, bleeding, infection, and scarring. ulcerous hemangiomas is terribly painful and frequently occur in association with chop-chop proliferating lesions. chop-chop proliferating hemangiomas of the face area unit significantly regarding as a result of they will compromise important structures or obscure vision. giant hemangiomas could also be related to Kasabach-Merritt syndrome, that contains a constellation of findings that features living substance destruction, anaemia, and coagulopathy. Hemangiomas are with success treated with lasers (ie, CW, PDL), excisional surgery, general corticosteroids, interferon, imiquimod, and surgical procedure.

Lymphangiomas

Lymphangiomas area unit slow-growing body fluid malformations which will be noninheritable  when body fluid drain obstruction, chronic inflammation, infections, trauma, or surgical procedures. However, most area unit innate and certain arise from a mixture of abnormal budding of body fluid structures, failure of blood vessel vasculature to unite with the lymphatics, and atypical lymphoid tissue sequestration throughout embryogenic development. Most of those lesions area unit diagnosed by age two years, with nearly 0.5 diagnosed at birth.

Lymphangiomas area unit generally found as soft tissue lots within the axillae or neck regions, however they will occur in different locations like the tongue, esophagus, and higher airways. These lesions is classified as either superficial or deep. AN example of a superficial lesion is angioma circumscriptum, whereas the cystic hygroma may be a deep body fluid malformation generally found within the neck. Lymphangiomas is found in patients with bound body abnormalities like Turner syndrome.

If the patient is well, a angioma might need no treatment; up to fifteen of cystic hygromas might ad lib regress. Surgical excision is usually the well-liked treatment modality; but, owing to the situation and doable involvement of significant structures, complete excision might not invariably be doable. different choices embrace sclerosing agents and optical device medical aid. roaring treatment with lasers (ie, argon beam, Nd:YAG, PDL, carbon dioxide) has been reportable. they need been used for ablation, debulking, and complete excision. However, several lesions recur and treatment might need varied sessions.

Acquired lesions

Telangiectasias

Telangiectasias area unit little, expanded vessels that area unit zero.1-1.5 millimeter in diameter. Telangiectasias usually occur on the face and lower extremities and area unit because of a spread of causes. Facial telangiectasias will occur ad lib, or they will be caused by excessive ultraviolet exposure, collagen-vascular sickness, acne, pregnancy, alcohol or oestrogen bodily process, or topical steroid hormone application. youngsters oft develop little facial telangiectasias that persist into adulthood. Lower extremity telangiectasias area unit a lot of common in ladies {and might|and should|and will} be genetic or may develop when gestation.

Treatment choices area unit varied and embrace sclerotherapy, electrodesiccation, and intense pulsed-light or optical device medical aid. Shorter optical device wavelengths are found to be more practical for treating redder, a lot of superficial vessels, however these parameters don't seem to be as roaring for deeper blue venulectasia and interlaced veins. The 1064-nm Nd:YAG optical device has been shown to with success improve lower extremity leg veins, particularly blue venulectasia and interlaced veins up to four millimeter in diameter. In one study, nearly 2 thirds of the patients achieved 75-100% clearing when just one optical device treatment; another study achieved vital clearing in eightieth with up to three irradiations. Transient physiological condition was the foremost common adverse result. Smaller leg telangiectasias might clear quicker and with less pain throughout treatment compared with larger vessels.

When sclerotherapy with zero.25% metallic element tetradecyl salt was compared with 1064-nm Nd:YAG optical device medical aid for lower extremity telangiectasias (0.1-1.5 mm), vital clinical improvement was seen altogether sites with either modality. However, earlier clearing and better average improvement scores were seen with sclerotherapy. each modalities were related to pain and localized tissue erythroderma and dropsy. Temporary postinflammatory physiological condition was seen solely with sclerotherapy.

Despite recent advances in optical device technology and also the effectiveness of lasers for facial telangiectasias, treatment of lower extremity telangiectasias with vascular-specific lasers is ineffective. Treatment failures area unit typically attributed to the larger size and deeper website of lower extremity vessels and their association with deeper, feeding blood vessel plexuses. For these reasons, sclerotherapy is taken into account first-line treatment for many telangiectatic leg veins.

Cherry angiomas

Cherry angiomas area unit little, well-circumscribed, bright-red tube-shaped structure proliferations that originally seem in early adulthood and increase in range with age. though benign, growths area unit simply treated with vascular-specific lasers to boost cosmesis.

Pyogenic granulomas

A pathology tumour is AN noninheritable , benign, tube-shaped structure connective tissue tumour which will additionally have an effect on secretion membranes. These lesions area unit usually found in infants and youngsters, accounting for roughly zero.5% of all skin nodules in youngsters. Clinically, pathology granulomas typically manifest as onerous, red papules on the top and neck that area unit chop-chop enlarging; they regularly bleed or ulcerate. Treatment choices embrace surgical excision, shave excision with concomitant electrodesiccation to the bottom, thermocautery alone, PDLs, and copper optical device systems.

Poikiloderma

Poikiloderma of Civatte clinically seems as a networklike, brown pigmentation of the neck, anterior chest, and lower face with distinguished telangiectasias caused by chronic sun exposure. Poikiloderma could also be with success treated with either the poundal or AN intense pulsed-light supply. the extreme pulsed-light supply might prove a lot of useful in eliminating associated physiological condition owing to its further result on dermal melanin; but, it's tougher to use, significantly in huffy areas like the neck and ches.


THE optical device SYSTEMS
Argon optical device

The CW chemical element optical device was the primary optical device system wont to treat telangiectasias. It emits blue-green lightweight, and eightieth of its emission falls among the 488- to 514-nm portion of the spectrum. optical device energy is delivered in an exceedingly continuous beam, with spot sizes starting from zero.1-1 mm, reaching tissue penetration depths of 1-2 millimeter. though argon's energy is preponderantly absorbed by oxyhaemoglobin, it's additionally absorbed to some extent by dermal and dermal animal pigment owing to its shorter wavelength. additionally, the laser's continuous mode of operation exceeds the thermal time constant of the tube-shaped structure target. Therefore, the chemical element optical device is related to a better prevalence of operative pigmentary alteration and pathology, and it typically isn't thought of helpful in darker-skinned people.

The {argon|Ar|atomic number one8|chemical element|element|noble gas|inert gas|argonon} laser's little spot size (up to 1 millimeter, compared with ten millimeter for the PDL) additionally limits effective dermal penetration, any contributory to clinical ineffectuality. Despite the very fact that the chemical element optical device is extremely operator-dependent and needs nice talent to by selection trace ectatic vessels while not destroying traditional tissue, it's the foremost roaring treatment sure enough noninheritable  tube-shaped structure lesions, as well as telangiectasias, cherry angiomas, and angiokeratomas. However, the recognition of the chemical element optical device has markedly declined over the past decade owing to its associated limitations and also the development of the poundal.

Argon-pumped tunable dye optical device

The argon-pumped tunable dye optical device (APTDL) may be a quasi-CW mode optical device with high specificity for connective tissue tube-shaped structure structures. This optical device produces lightweight with wavelengths starting from 488-638 nm and might be operated within the yellow 577- to 585-nm vary for improved absorption by hemoprotein. though the optical device is closed to deliver pulse periods as short as twenty milliseconds, most clinical applications need a minimum of a 100-millisecond period, that is way longer than the thermal time constant of telangiectatic vessels. Individual vessels area unit generally copied employing a 100-mm spot size and power settings of zero.1-0.4 W.

Adverse effects embrace symptom scarring, hypertrophic scarring, and permanent pigmentary alteration. a better prevalence of scarring is seen with the APTDL compared with the poundal owing to the quasicontinuous nature of the previous system; but, as a result of the APTDL ends up in less operative blood disorder and physiological condition than the poundal, some patients might like the APTDL.

Potassium titanyl phosphate crystal optical device

The atomic number 19 titanyl phosphate (KTP) optical device uses a 1064-nm Nd:YAG supply skilled a KTP crystal to emit lightweight that's frequency-doubled with a wavelength of 532 nm. This quasi-CW optical device system uses unit of time pulses to destroy tube-shaped structure targets. The KTP laser's 532-nm wavelength corresponds with the 542-nm absorption peak of oxyhaemoglobin, that makes it comparatively specific for connective tissue blood vessels. though the short wavelength doesn't provide deep tissue penetration, extended pulse periods up to fifty milliseconds improve its effectiveness. The KTP optical device is commonly wont to treat telangiectasias, and multiple treatments area unit necessary for larger-caliber vessels. almost like the quasi-CW chemical element system, less blood disorder, swelling, and pain area unit related to KTP optical device irradiation, however clinical results area unit systematically superior with the poundal.

Copper vapor and copper bromide lasers

Copper vapor and copper bromide lasers emit traffic signal with a wavelength of 578 nm. These quasi-CW mode lasers deliver fast, 20-nanosecond pulses at a repetition rate of half dozen,000-15,000 pulses per second. Therefore, they're higher fitted to the treatment of larger-caliber vessels with longer thermal relaxation times as a result of they need a bent to supply raised thermal gangrene in tissue. Facial telangiectasias, cherry angiomas, and pathology granulomas are eradicated with success with copper vapor and copper bromide systems. Absorption of energy by dermal and dermal animal pigment additionally happens, creating operative pigmentary alterations common. Thus, as a result of darker-skinned people area unit a lot of probably to expertise vital postinflammatory pigmentary changes, the utilization of either optical device ought to be restricted to patients with Fitzpatrick skin phototypes I-II. different posttreatment adverse effects embrace fine crusting and blistering that typically resolve over a 2-week amount.

Krypton optical device

The atomic number 36 optical device may be a quasi-CW mode optical device that emits inexperienced lightweight at 520-530 nm and traffic signal at 568 nm. The 568-nm atomic number 36 optical device has been advocated for the treatment of facial telangiectasias. Vessels area unit copied employing a 1-mm handpiece with pulse period of zero.2 seconds and power settings starting from zero.5-0.75 W till the vessel disappears fully. like different quasi-CW optical device systems, multiple treatment sessions at 3- to 4-week intervals area unit typically necessary. the foremost common adverse effects embrace erythroderma, edema, and delicate blistering or crusting.

Flashlamp-pumped poundal

Light energy emitted by the flashlamp-pumped poundal is primarily absorbed by oxyhaemoglobin contained among tube-shaped structure lumina, so minimizing thermal injury to different structures. The poundal was originally on the market at a wavelength of 577 nm, corresponding directly with the third absorption peak of oxyhaemoglobin, and a pulse period of 450 microseconds.

Over the past decade, the wavelength was extended to 585 nm and also the pulse period was raised to one.5 milliseconds to result deeper tissue penetration while not compromising absorption by hemoprotein. Also, a more moderen 595-nm ultralong-PDL is adjusted for pulse durations from one.5-40 milliseconds. it's a cryogen-cooling device to decrease pain and adverse effects (eg, purpura). The longer-wavelength optical device will result even deeper penetration than the 585-nm optical device and should be favorable for treating bound telangiectasias. Typically, larger-caliber vessels need longer pulse durations to be effective, and also the 595-nm poundal is adjusted to correspond to the different-sized vessels being treated.

The poundal is taken into account the criterion customary treatment for port-wine stains, and it is wont to treat infants aged solely a number of weeks. The poundal is beneficial within the treatment of superficial hemangiomas and in an exceedingly type of noninheritable  connective tissue tube-shaped structure lesions, as well as telangiectasias, cherry angiomas, pathology granulomas, and poikiloderma of Civatte. pathology granulomas have additionally been with success treated with the 585-nm poundal. However, some thicker lesions might not reply to medical aid as a result of they're too deep. Some advocate multiple, overlapping pulses to treat these lesions; but, others compress the superficial vessels with a glass slide so administer the optical device. when the deeper portion has been treated, the slide is removed and also the superficial portion is treated. poundal treatment is particularly effective for reducing diffuse erythroderma and matted telangiectasias related to acne, property injury, and semipermanent steroid hormone use.

Laser treatment parameters area unit supported many factors, as well as lesion location, lesion morphology, and patient skin kind. Spot sizes starting from 2-10 millimeter area unit wont to deliver a fluence averaging 5-10 J/cm2. the utilization of larger spot sizes and a better fluence permits deeper dermal penetration and destruction of larger-caliber vessels. Lower energy densities area unit necessary in ANatomic locations with an raised risk of scarring, like the anterior chest, neck, and periorbital space. The doc ought to additionally apply optical device pulses in an exceedingly nonoverlapping manner to stop excessive thermal injury that would end in organic process and pathology.

In general, expect port-wine stains to fade by eightieth when 8-10 treatments. Lesions on the face or neck tend to retort a lot of quickly than those on the lower extremities. Superficial and ulcerous hemangiomas additionally respond favourably to the PDL; but, hemangiomas with a deeper element tend to be a lot of immune to optical device medical aid, typically requiring concomitant corticosteroids. Port-wine stains treated with the poundal and a cryogen-cooling device are shown to possess a considerably higher response at 585 nm than at 595 nm. Another study compared the consequences of employing a 595-nm poundal for port-wine stains that were refractory to treatment at 585 nm. No applied mathematics advantage was found for victimisation the longer wavelength for treatment. However, {it might|it's going to|it should} be advantageous to try a check spot at 595 nm to see if any further profit may occur with this wavelength.

The most common adverse effects embrace transient dropsy and blood disorder, which can last up to 7-14 days. As a consequence, patients might like treatment with a 532-nm KTP optical device despite the superior efficaciousness of the poundal so as to eradicate telangiectasias with fewer treatments. though the utilization of smaller spot sizes and lower energy densities reduces the degree of blood disorder, these measures additionally decrease clinical efficaciousness. different potential posttreatment adverse effects embrace transient physiological state or physiological condition, significantly in dark-skinned or tanned people.

The use of a dynamic cooling device, that serves to chill the cuticle throughout optical device irradiation, permits safe application of a better fluence, even in patients with dark skin tones. The cooling device additionally reduces the intensity and period of operative blood disorder.

Intense periodical noncoherent lightweight

A noncoherent pulsed-light supply that emits Christ Within the 500- to 1200-nm portion of the spectrum also can be wont to treat a spread of connective tissue tube-shaped structure disorders. reckoning on lesion kind and size, cutoff filters of variable wavelengths (515 nm, 550 nm, 570 nm, 590 nm) area unit wont to eliminate shorter wavelengths. lightweight is delivered in an exceedingly train of single, double, or triple pulses (2-25 milliseconds each) with variable time intervals between pulses (10-500 milliseconds). this method is extremely operator-dependent and permits treatment parameters (ie, wavelength, pulse duration, delays between pulses) to be tailored for every use.

The noncoherent pulsed-light supply has been wont to treat port-wine stains, hemangiomas, and facial or lower extremity telangiectasias. Smaller-caliber vessels respond best to treatment with lower cutoff filters (515 or 550 nm); larger-caliber vessels need longer-wavelength filters to result deeper tissue penetration. as a result of shorter-wavelength filters move a lot of without delay with dermal and dermal animal pigment, these filters ought to be reserved for treating fair-skinned people (Fitzpatrick skin phototypes I-II). Smaller vessels area unit typically treated with single two.5- to 5-millisecond pulses and a fluence starting from 25-45 J/cm2.


Higher energy densities (50-75 J/cm2) area unit used on larger vessels as a result of the energy is run as a train of pulses with long (40-60 milliseconds) delays between pulses. Higher energy densities allow adequate action whereas at the same time protective the superjacent cuticle and periadnexal structures from excessive thermal injury. This mechanism of additive heating permits treatment of a lot of deeply located vessels gift in hypertrophic port-wine stains or cavernous tube-shaped structure lesions. The 515-nm filter is employed for initial treatment, followed by the 550-nm filter to higher target larger, a lot of deeply located telangiectasias. Adverse effects area unit delicate and embrace transient erythroderma and blood disorder.

CONCLUSIONS
Congenital and purchased connective tissue tube-shaped structure lesions is treated effectively with a spread of quasi-CW and periodical lasers. though the quasi-CW mode lasers (ie, APTDL, KTP, copper vapor, krypton) will treat facial telangiectasias and different tube-shaped structure growths, the poundal has become the criterion customary of treatment owing to its superior clinical efficaciousness and low complication rate. However, patients with darker skin varieties UN agency want treatment ought to be properly knowledgeable of the potential pigmentation changes and different adverse effects which will occur when poundal treatment.

Quasi-CW optical device systems is used for treating larger-caliber vessels, that need delivery of a better fluence. additionally, some patients like quasi-CW lasers owing to the weakened incidence of operative blood disorder. when poundal treatment, most patients expertise some extent of erythroderma or blood disorder, which might last 7-14 days. Despite these transient adverse effects, the poundal produces the foremost fast vessel clearance, with fewer overall treatments needed to eradicate lesions.

Laser medical aid continues to advance within the treatment of unsought veins and telangiectasias. Shorter wavelengths are more practical for a lot of superficial, red telangiectasias; whereas, longer wavelengths are a lot of roaring for treating deeper blue venulectasia and interlaced veins up to four millimeter in diameter. as a result of lower extremity telangiectasias is immune to vascular-specific optical device irradiation, sclerotherapy is that the initial treatment of alternative for many patients. a mixture approach victimisation sclerotherapy to treat the feeding interlaced veins and optical device irradiation to focus on the superficial telangiectasias might enhance vessel clearance. the extreme pulsed-light supply has additionally been roaring within the treatment of lower leg veins. Patients with matted telangiectasias, distinguished veins below the articulatio plana, or veins immune to sclerotherapy area unit ideal candidates for optical device treatment.

Importantly, bear in mind that patients ought to avoid reserve sun exposure before, during, and when optical device treatment as a result of sun exposure might decrease the efficaciousness of the procedure and should contribute to adverse events like operative pigmentation changes. As analysis within the field continues, lasers capable of removing ectatic tube-shaped structure growths, in spite of size or location, with least risk and low morbidity can probably become on the market. any analysis is required to optimize these treatments.



بر گرفته از emedicine -education -کتاب لیزر پوست و زیبایی

Laser treatment of connective tissue tube-shaped structure lesions has progressed considerably over the past twenty years. supported the pioneering work of Anderson and Maxfield Frederick Parrish within the early Eighties, many vascular-specific optical device systems are developed victimisation principles of selective photothermolysis.

Laser irradiation will by selection destroy specific targets (chromophores) among the skin by victimisation AN acceptable wavelength and pulse period. Pulse period should be but or capable the targeted thermal time constant of the radical, ie, the time necessary for the target to chill by 1/2 its peak temperature when optical device irradiation. as a result of the energy deposited within the tissue is proscribed to targeted sites, vital thermal diffusion to adjacent skin is prevented. additionally, as a result of wavelengths adore absorption peaks for varied skin chromophores area unit acknowledged, absorption of optical device energy is localized while not damaging neighboring structures. The targeted radical for tube-shaped structure lesions is intravascular oxyhemoglobin; so, thermal injury is basically restricted to connective tissue blood vessels.

Early optical device technology used continuous-wave (CW) mode lasers for treating connective tissue tube-shaped structure lesions. These lasers didn't prohibit injury to the targeted tube-shaped structure structures, and, consequently, their use resulted in an exceedingly high prevalence of scarring. periodical optical device systems, like the 585-nm periodical dye optical device (PDL), afterward were developed and became the mainstays of medical aid for each innate and purchased tube-shaped structure lesions. These lasers provide glorious clinical improvement with a coffee risk of adverse sequelae. Transient blood disorder is that the commonest adverse result of poundal treatment. Current technologic enhancements embrace dynamic surface cooling and extended pulse period, that enhance clinical results and minimize adverse effects.

CLASSIFICATION OF connective tissue tube-shaped structure LESIONS
Cutaneous tube-shaped structure lesions area unit classified in keeping with mode and age of onset. innate lesions begin in infancy and embrace port-wine stains, hemangiomas, blood vessel malformations, and lymphangiomas. innate lesions area unit found most typically on the top or neck and should be isolated or found as a part of a innate syndrome like Sturge-Weber syndrome. noninheritable  lesions develop in persons of any age and embrace telangiectasias, cherry angiomas, pathology granulomas, blood vessel lakes, poikiloderma, and Kaposi malignant neoplastic disease. noninheritable  lesions might occur ad lib, or they will be caused by trauma, ultraviolet exposure, or secretion changes.

Congenital lesions:

Port-wine stains

Port-wine stains, additionally called nevus or capillary malformations, area unit gift at birth and occur equally in each sexes. The prevalence rate within the general population is zero.3-0.5%. Lesions tend to grow with the patient, while not a bent towards regression. they're typically set on the face, and also the V2 surgical instrument is affected most typically. at first showing as light-pink macules, port-wine stains will darken over time as a results of progressive vessel ectasis. superjacent soft tissue or bony hypertrophy could also be related to these lesions. Use of the poundal is that the most popular treatment owing to its superior efficaciousness and low prevalence of adverse effects.

Hemangiomas

Hemangiomas area unit benign proliferations of blood vessels occurring in one0-12% of all youngsters by age 1 year. just one third of hemangiomas area unit gift at birth, and most area unit solitary lesions that occur on the top or neck. They generally bear a rapid climb part before involuting when AN undetermined quantity of your time. though some involution typically begins by the top of the primary year, several hemangiomas don't fully involute till the kid is aged 10-12 years.

Associated complications embrace ulceration, bleeding, infection, and scarring. ulcerous hemangiomas is terribly painful and frequently occur in association with chop-chop proliferating lesions. chop-chop proliferating hemangiomas of the face area unit significantly regarding as a result of they will compromise important structures or obscure vision. giant hemangiomas could also be related to Kasabach-Merritt syndrome, that contains a constellation of findings that features living substance destruction, anaemia, and coagulopathy. Hemangiomas are with success treated with lasers (ie, CW, PDL), excisional surgery, general corticosteroids, interferon, imiquimod, and surgical procedure.

Lymphangiomas

Lymphangiomas area unit slow-growing body fluid malformations which will be noninheritable  when body fluid drain obstruction, chronic inflammation, infections, trauma, or surgical procedures. However, most area unit innate and certain arise from a mixture of abnormal budding of body fluid structures, failure of blood vessel vasculature to unite with the lymphatics, and atypical lymphoid tissue sequestration throughout embryogenic development. Most of those lesions area unit diagnosed by age two years, with nearly 0.5 diagnosed at birth.

Lymphangiomas area unit generally found as soft tissue lots within the axillae or neck regions, however they will occur in different locations like the tongue, esophagus, and higher airways. These lesions is classified as either superficial or deep. AN example of a superficial lesion is angioma circumscriptum, whereas the cystic hygroma may be a deep body fluid malformation generally found within the neck. Lymphangiomas is found in patients with bound body abnormalities like Turner syndrome.

If the patient is well, a angioma might need no treatment; up to fifteen of cystic hygromas might ad lib regress. Surgical excision is usually the well-liked treatment modality; but, owing to the situation and doable involvement of significant structures, complete excision might not invariably be doable. different choices embrace sclerosing agents and optical device medical aid. roaring treatment with lasers (ie, argon beam, Nd:YAG, PDL, carbon dioxide) has been reportable. they need been used for ablation, debulking, and complete excision. However, several lesions recur and treatment might need varied sessions.

Acquired lesions

Telangiectasias

Telangiectasias area unit little, expanded vessels that area unit zero.1-1.5 millimeter in diameter. Telangiectasias usually occur on the face and lower extremities and area unit because of a spread of causes. Facial telangiectasias will occur ad lib, or they will be caused by excessive ultraviolet exposure, collagen-vascular sickness, acne, pregnancy, alcohol or oestrogen bodily process, or topical steroid hormone application. youngsters oft develop little facial telangiectasias that persist into adulthood. Lower extremity telangiectasias area unit a lot of common in ladies {and might|and should|and will} be genetic or may develop when gestation.

Treatment choices area unit varied and embrace sclerotherapy, electrodesiccation, and intense pulsed-light or optical device medical aid. Shorter optical device wavelengths are found to be more practical for treating redder, a lot of superficial vessels, however these parameters don't seem to be as roaring for deeper blue venulectasia and interlaced veins. The 1064-nm Nd:YAG optical device has been shown to with success improve lower extremity leg veins, particularly blue venulectasia and interlaced veins up to four millimeter in diameter. In one study, nearly 2 thirds of the patients achieved 75-100% clearing when just one optical device treatment; another study achieved vital clearing in eightieth with up to three irradiations. Transient physiological condition was the foremost common adverse result. Smaller leg telangiectasias might clear quicker and with less pain throughout treatment compared with larger vessels.

When sclerotherapy with zero.25% metallic element tetradecyl salt was compared with 1064-nm Nd:YAG optical device medical aid for lower extremity telangiectasias (0.1-1.5 mm), vital clinical improvement was seen altogether sites with either modality. However, earlier clearing and better average improvement scores were seen with sclerotherapy. each modalities were related to pain and localized tissue erythroderma and dropsy. Temporary postinflammatory physiological condition was seen solely with sclerotherapy.

Despite recent advances in optical device technology and also the effectiveness of lasers for facial telangiectasias, treatment of lower extremity telangiectasias with vascular-specific lasers is ineffective. Treatment failures area unit typically attributed to the larger size and deeper website of lower extremity vessels and their association with deeper, feeding blood vessel plexuses. For these reasons, sclerotherapy is taken into account first-line treatment for many telangiectatic leg veins.

Cherry angiomas

Cherry angiomas area unit little, well-circumscribed, bright-red tube-shaped structure proliferations that originally seem in early adulthood and increase in range with age. though benign, growths area unit simply treated with vascular-specific lasers to boost cosmesis.

Pyogenic granulomas

A pathology tumour is AN noninheritable , benign, tube-shaped structure connective tissue tumour which will additionally have an effect on secretion membranes. These lesions area unit usually found in infants and youngsters, accounting for roughly zero.5% of all skin nodules in youngsters. Clinically, pathology granulomas typically manifest as onerous, red papules on the top and neck that area unit chop-chop enlarging; they regularly bleed or ulcerate. Treatment choices embrace surgical excision, shave excision with concomitant electrodesiccation to the bottom, thermocautery alone, PDLs, and copper optical device systems.

Poikiloderma

Poikiloderma of Civatte clinically seems as a networklike, brown pigmentation of the neck, anterior chest, and lower face with distinguished telangiectasias caused by chronic sun exposure. Poikiloderma could also be with success treated with either the poundal or AN intense pulsed-light supply. the extreme pulsed-light supply might prove a lot of useful in eliminating associated physiological condition owing to its further result on dermal melanin; but, it's tougher to use, significantly in huffy areas like the neck and ches.


THE optical device SYSTEMS
Argon optical device

The CW chemical element optical device was the primary optical device system wont to treat telangiectasias. It emits blue-green lightweight, and eightieth of its emission falls among the 488- to 514-nm portion of the spectrum. optical device energy is delivered in an exceedingly continuous beam, with spot sizes starting from zero.1-1 mm, reaching tissue penetration depths of 1-2 millimeter. though argon's energy is preponderantly absorbed by oxyhaemoglobin, it's additionally absorbed to some extent by dermal and dermal animal pigment owing to its shorter wavelength. additionally, the laser's continuous mode of operation exceeds the thermal time constant of the tube-shaped structure target. Therefore, the chemical element optical device is related to a better prevalence of operative pigmentary alteration and pathology, and it typically isn't thought of helpful in darker-skinned people.

The {argon|Ar|atomic number one8|chemical element|element|noble gas|inert gas|argonon} laser's little spot size (up to 1 millimeter, compared with ten millimeter for the PDL) additionally limits effective dermal penetration, any contributory to clinical ineffectuality. Despite the very fact that the chemical element optical device is extremely operator-dependent and needs nice talent to by selection trace ectatic vessels while not destroying traditional tissue, it's the foremost roaring treatment sure enough noninheritable  tube-shaped structure lesions, as well as telangiectasias, cherry angiomas, and angiokeratomas. However, the recognition of the chemical element optical device has markedly declined over the past decade owing to its associated limitations and also the development of the poundal.

Argon-pumped tunable dye optical device

The argon-pumped tunable dye optical device (APTDL) may be a quasi-CW mode optical device with high specificity for connective tissue tube-shaped structure structures. This optical device produces lightweight with wavelengths starting from 488-638 nm and might be operated within the yellow 577- to 585-nm vary for improved absorption by hemoprotein. though the optical device is closed to deliver pulse durations as short as twenty milliseconds, most clinical applications need a minimum of a 100-millisecond period, that is way longer than the thermal time constant of telangiectatic vessels. Individual vessels area unit generally copied employing a 100-mm spot size and power settings of zero.1-0.4 W.

Adverse effects embrace symptom scarring, hypertrophic scarring, and permanent pigmentary alteration. a better prevalence of scarring is seen with the APTDL compared with the poundal owing to the quasicontinuous nature of the previous system; but, as a result of the APTDL ends up in less operative blood disorder and physiological condition than the poundal, some patients might like the APTDL.

Potassium titanyl phosphate crystal optical device

The atomic number 19 titanyl phosphate (KTP) optical device uses a 1064-nm Nd:YAG supply skilled a KTP crystal to emit lightweight that's frequency-doubled with a wavelength of 532 nm. This quasi-CW optical device system uses unit of time pulses to destroy tube-shaped structure targets. The KTP laser's 532-nm wavelength corresponds with the 542-nm absorption peak of oxyhaemoglobin, that makes it comparatively specific for connective tissue blood vessels. though the short wavelength doesn't provide deep tissue penetration, extended pulse durations up to fifty milliseconds improve its effectiveness. The KTP optical device is commonly wont to treat telangiectasias, and multiple treatments area unit necessary for larger-caliber vessels. almost like the quasi-CW chemical element system, less blood disorder, swelling, and pain area unit related to KTP optical device irradiation, however clinical results area unit systematically superior with the poundal.

Copper vapor and copper bromide lasers

Copper vapor and copper bromide lasers emit traffic signal with a wavelength of 578 nm. These quasi-CW mode lasers deliver fast, 20-nanosecond pulses at a repetition rate of half dozen,000-15,000 pulses per second. Therefore, they're higher fitted to the treatment of larger-caliber vessels with longer thermal relaxation times as a result of they need a bent to supply raised thermal gangrene in tissue. Facial telangiectasias, cherry angiomas, and pathology granulomas are eradicated with success with copper vapor and copper bromide systems. Absorption of energy by dermal and dermal animal pigment additionally happens, creating operative pigmentary alterations common. Thus, as a result of darker-skinned people area unit a lot of probably to expertise vital postinflammatory pigmentary changes, the utilization of either optical device ought to be restricted to patients with Fitzpatrick skin phototypes I-II. different posttreatment adverse effects embrace fine crusting and blistering that typically resolve over a 2-week amount.

Krypton optical device

The atomic number 36 optical device may be a quasi-CW mode optical device that emits inexperienced lightweight at 520-530 nm and traffic signal at 568 nm. The 568-nm atomic number 36 optical device has been advocated for the treatment of facial telangiectasias. Vessels area unit copied employing a 1-mm handpiece with pulse period of zero.2 seconds and power settings starting from zero.5-0.75 W till the vessel disappears fully. like different quasi-CW optical device systems, multiple treatment sessions at 3- to 4-week intervals area unit typically necessary. the foremost common adverse effects embrace erythroderma, edema, and delicate blistering or crusting.

Flashlamp-pumped poundal

Light energy emitted by the flashlamp-pumped poundal is primarily absorbed by oxyhaemoglobin contained among tube-shaped structure lumina, so minimizing thermal injury to different structures. The poundal was originally on the market at a wavelength of 577 nm, corresponding directly with the third absorption peak of oxyhaemoglobin, and a pulse period of 450 microseconds.

Over the past decade, the wavelength was extended to 585 nm and also the pulse period was raised to one.5 milliseconds to result deeper tissue penetration while not compromising absorption by hemoprotein. Also, a more moderen 595-nm ultralong-PDL is adjusted for pulse durations from one.5-40 milliseconds. it's a cryogen-cooling device to decrease pain and adverse effects (eg, purpura). The longer-wavelength optical device will result even deeper penetration than the 585-nm optical device and should be favorable for treating bound telangiectasias. Typically, larger-caliber vessels need longer pulse durations to be effective, and also the 595-nm poundal is adjusted to correspond to the different-sized vessels being treated.

The poundal is taken into account the criterion customary treatment for port-wine stains, and it is wont to treat infants aged solely a number of weeks. The poundal is beneficial within the treatment of superficial hemangiomas and in an exceedingly type of noninheritable  connective tissue tube-shaped structure lesions, as well as telangiectasias, cherry angiomas, pathology granulomas, and poikiloderma of Civatte. pathology granulomas have additionally been with success treated with the 585-nm poundal. However, some thicker lesions might not reply to medical aid as a result of they're too deep. Some advocate multiple, overlapping pulses to treat these lesions; but, others compress the superficial vessels with a glass slide so administer the optical device. when the deeper portion has been treated, the slide is removed and also the superficial portion is treated. poundal treatment is particularly effective for reducing diffuse erythroderma and matted telangiectasias related to acne, property injury, and semipermanent steroid hormone use.

Laser treatment parameters area unit supported many factors, as well as lesion location, lesion morphology, and patient skin kind. Spot sizes starting from 2-10 millimeter area unit wont to deliver a fluence averaging 5-10 J/cm2. the utilization of larger spot sizes and a better fluence permits deeper dermal penetration and destruction of larger-caliber vessels. Lower energy densities area unit necessary in ANatomic locations with an raised risk of scarring, like the anterior chest, neck, and periorbital space. The doc ought to additionally apply optical device pulses in an exceedingly nonoverlapping manner to stop excessive thermal injury that would end in organic process and pathology.

In general, expect port-wine stains to fade by eightieth when 8-10 treatments. Lesions on the face or neck tend to retort a lot of quickly than those on the lower extremities. Superficial and ulcerous hemangiomas additionally respond favourably to the PDL; but, hemangiomas with a deeper element tend to be a lot of immune to optical device medical aid, typically requiring concomitant corticosteroids. Port-wine stains treated with the poundal and a cryogen-cooling device are shown to possess a considerably higher response at 585 nm than at 595 nm. Another study compared the consequences of employing a 595-nm poundal for port-wine stains that were refractory to treatment at 585 nm. No applied mathematics advantage was found for victimisation the longer wavelength for treatment. However, {it might|it's going to|it should} be advantageous to try a check spot at 595 nm to see if any further profit may occur with this wavelength.

The most common adverse effects embrace transient dropsy and blood disorder, which can last up to 7-14 days. As a consequence, patients might like treatment with a 532-nm KTP optical device despite the superior efficaciousness of the poundal so as to eradicate telangiectasias with fewer treatments. though the utilization of smaller spot sizes and lower energy densities reduces the degree of blood disorder, these measures additionally decrease clinical efficaciousness. different potential posttreatment adverse effects embrace transient physiological state or physiological condition, significantly in dark-skinned or tanned people.

The use of a dynamic cooling device, that serves to chill the cuticle throughout optical device irradiation, permits safe application of a better fluence, even in patients with dark skin tones. The cooling device additionally reduces the intensity and period of operative blood disorder.

Intense periodical noncoherent lightweight = لیزر حرارتی

A noncoherent pulsed-light supply that emits Christ Within the 500- to 1200-nm portion of the spectrum also can be wont to treat a spread of connective tissue tube-shaped structure disorders. reckoning on lesion kind and size, cutoff filters of variable wavelengths (515 nm, 550 nm, 570 nm, 590 nm) area unit wont to eliminate shorter wavelengths. lightweight is delivered in an exceedingly train of single, double, or triple pulses (2-25 milliseconds each) with variable time intervals between pulses (10-500 milliseconds). this method is extremely operator-dependent and permits treatment parameters (ie, wavelength, pulse duration, delays between pulses) to be tailored for every use.

The noncoherent pulsed-light supply has been wont to treat port-wine stains, hemangiomas, and facial or lower extremity telangiectasias. Smaller-caliber vessels respond best to treatment with lower cutoff filters (515 or 550 nm); larger-caliber vessels need longer-wavelength filters to result deeper tissue penetration. as a result of shorter-wavelength filters move a lot of without delay with dermal and dermal animal pigment, these filters ought to be reserved for treating fair-skinned people (Fitzpatrick skin phototypes I-II). Smaller vessels area unit typically treated with single two.5- to 5-millisecond pulses and a fluence starting from 25-45 J/cm2.


Higher energy densities (50-75 J/cm2) area unit used on larger vessels as a result of the energy is run as a train of pulses with long (40-60 milliseconds) delays between pulses. Higher energy densities allow adequate action whereas at the same time protective the superjacent cuticle and periadnexal structures from excessive thermal injury. This mechanism of additive heating permits treatment of a lot of deeply located vessels gift in hypertrophic port-wine stains or cavernous tube-shaped structure lesions. The 515-nm filter is employed for initial treatment, followed by the 550-nm filter to higher target larger, a lot of deeply located telangiectasias. Adverse effects area unit delicate and embrace transient erythroderma and blood disorder.

CONCLUSIONS
Congenital and purchased connective tissue tube-shaped structure lesions is treated effectively with a spread of quasi-CW and periodical lasers. though the quasi-CW mode lasers (ie, APTDL, KTP, copper vapor, krypton) will treat facial telangiectasias and different tube-shaped structure growths, the poundal has become the criterion customary of treatment owing to its superior clinical efficaciousness and low complication rate. However, patients with darker skin varieties UN agency want treatment ought to be properly knowledgeable of the potential pigmentation changes and different adverse effects which will occur when poundal treatment.

Quasi-CW optical device systems is used for treating larger-caliber vessels, that need delivery of a better fluence. additionally, some patients like quasi-CW lasers owing to the weakened incidence of operative blood disorder. when poundal treatment, most patients expertise some extent of erythroderma or blood disorder, which might last 7-14 days. Despite these transient adverse effects, the poundal produces the foremost fast vessel clearance, with fewer overall treatments needed to eradicate lesions.

Laser medical aid continues to advance within the treatment of unsought veins and telangiectasias. Shorter wavelengths are more practical for a lot of superficial, red telangiectasias; whereas, longer wavelengths are a lot of roaring for treating deeper blue venulectasia and interlaced veins up to four millimeter in diameter. as a result of lower extremity telangiectasias is immune to vascular-specific optical device irradiation, sclerotherapy is that the initial treatment of alternative for many patients. a mixture approach victimisation sclerotherapy to treat the feeding interlaced veins and optical device irradiation to focus on the superficial telangiectasias might enhance vessel clearance. the extreme pulsed-light supply has additionally been roaring within the treatment of lower leg veins. Patients with matted telangiectasias, distinguished veins below the articulatio plana, or veins immune to sclerotherapy area unit ideal candidates for optical device treatment.

Importantly, bear in mind that patients ought to avoid reserve sun exposure before, during, and when optical device treatment as a result of sun exposure might decrease the efficaciousness of the procedure and should contribute to adverse events like operative pigmentation changes. As analysis within the field continues, lasers capable of removing ectatic tube-shaped structure growths, in spite of size or location, with least risk and low morbidity can probably become on the market. any analysis is required to optimize these treatments.