Post-Laser Vascular Reaction Management

Patient description

I would like to share a case and ask for colleagues’ input regarding post-laser care for vascular lesions.

A patient underwent her first Fotona 1064 nm laser session for telangiectasias on the legs. The parameters were 1064 nm, VERSA mode, 4 mm spot size, 20 ms, 180 J, with Zimmer parallel cooling.

The patient has a history of multiple sclerotherapy sessions performed at other centers, but due to the extent of her telangiectasias, she was never treated comprehensively.

Clinical course:

• During treatment, both the telangiectasias and the surrounding skin responded as expected, with no adverse surface lesions.

• The following day, the patient presented with intense erythematous/inflammatory appearance of the treated telangiectasias, but no epidermal injury or blistering.

• She remains otherwise well and asymptomatic.

Initial Management:
I indicated topical hydrocortisone 1% cream, TID for 7 days.

Attached images:

• Baseline 

• 24 hours post-treatment 

• Day 5 post-treatment

Case description

1. What topical creams or adjuncts do you recommend to support the healing process in such cases?

2. Do you agree with the use of mild topical corticosteroids, or would you choose a different approach?

3. Any role for emollients, vascular-stabilizing agents, or other topical therapies in your experience?

4. How would you expect the healing course to progress in this type of case?

5. What would you do differently to prevent this inflammatory/erythematous reaction in her next session?