1. In a retrospective review of over 140 infants with infantile hemangiomas (IH), combined neodymium-doped yttrium aluminum garnet laser and pulsed dye laser (Nd:YAG/PDL) therapy was efficacious in the treatment of IH.
2. Nd:YAG/PDL treatments were effective for any classification or phase of IF.
Evidence Rating Level: 3 (Average)
Study Rundown: IH is the most common vascular tumor in infants, and is characterized by a proliferation, plateau, and spontaneous involution phase. No treatment is recommended in most cases due to spontaneous regression; however, approximately 10 to 15% of cases require treatment, traditionally with oral propranolol, due to the risk of ulceration, functional impairment, or cosmetic disfiguration. Previous studies have demonstrated that PDL may be effective in superficial IH. However, there has been a paucity of evidence in the role of combined Nd:YAG/PDL, which has the ability to reach deeper dermal structures. The purpose of this study was to assess the potential role of combined Nd:YAG/PDL therapy for IH.
This study retrospectively evaluated the treatment outcomes of 149 infants with IH 4 to 6 weeks following treatment with PDL or Nd:YAG/PDL. At the conclusion of the study, moderate to strong improvement of IH was achieved in over 92% of patients. Only 3 of 149 patients (2%) demonstrated relapse of IH following laser treatment. Overall, Nd:YAG/PDL therapy was able to treat any classification or phase of IH. Furthermore, only local AE were observed with Nd:YAG/PDL. The study supports the hypothesis that Nd:YAG/PDL can serve as a viable alternative for the treatment of IH. The study is strengthened by its large cohort and baseline IH characteristics consistent with previously published literature. However, the study is limited by the lack of a control group, lack of randomization, use of a single center, and the fact that clinical outcomes were evaluated by 2 physicians who were also involved in the administration of treatments. Larger, multi-center, randomized, controlled trials where evaluators are blinded may improve the validity of the study.
In-Depth [retrospective cohort]: This study retrospectively evaluated the use of PDL and Nd:YAG/PDL in the treatment of infants with IH of any classification (cutaneous, mixed type, or subcutaneous) or stage (proliferation, plateau, or involution) at a single specialty center in Germany. Overall, 149 infants were identified with 238 IH (69 IH treated with PDL and 169 IH treated with Nd:YAG/PDL). All patients required treatment due to rapid growth of IH, functional impairment, or disfiguration. PDL was performed for solitary superficial hemangiomas while Nd:YAG/PDL was utilized for deeper lesions. Clinical outcome was assessed by 3 different physicians and evaluated based on improvement in clearance, color, thickness, or vascularization. At the conclusion of the study, IH treated with laser demonstrated moderate-to-strong improvement in 92.4% of cases (91.1% in Nd:YAG/PDL and 95.6% in PDL). The relapse rate was 2% and the failure rate was 3.6%. With respect to AE, no serious systemic AE were observed. The most common local AE were blistering and crusting, which was observed in 21.2% and 8.3% of cases, respectively.
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