Objectives: To explain why I prefer vascular lasers for the treatment of vascular conditions, although I also use IPL for adquate patients.
Introduction: Lasers offer significant opportunities to manage a variety of vascular conditions. PWS were initially the only lesions elegible for treatment by vascular lasers, but as technology has improved, the spectrum of vascular lesions susceptible to treatment with laser has expanded. Pulsed Dye Laser (PDL) still remains the gold standard for treating PWS in children.
Materials / method: The original PDL had a pulse duration of 0.45 ms. PDL systems have now been developed that allow for adjustment of the pulse duration and wavelength. The spot size has increased from 3mm to 15 mm and the power emitted by the lasers has increased significantly. Cooling units are attached to the laser systems to allow protection of the epidermis during laser treatment at these higher energies and to reduce patient discomfort. Nd:YAG is a more powerful lasers than reachs deeply into the skin and is useful for thicker vascular lesions as venous malformations, telangiectasias or pyogenic granulomas
Results: New modalities of PDL have been developed in the past decade. A recent combined modality laser system can deliver pulsed sequential light at 595 nm in a first pulse followed by a 1064 nm second pulse.
Intense pulsed light devices (IPL) with non-coherent light ranging from 500 to 1200 nm can also represent an option for vascular lesions. Different filters can be used in order to focus their impact mainly on vascular targets. Many devices are available in the market, each of them with different features regarding the spectrum of wavelengths covered, pulse durations and fluences.
Conclusion: Newer devices are capable of emitting higher energies with shorter pulses in the range of milliseconds or even shorter, positioning them as a valid alternative to PDL for the treatment of resistant PWS and other vascular lesions. However, medical literature is overwhelmingly majority with vascular lasers than with IPL systems
Moreover there are many other non-vascular conditions than can be treated with vascular lasers where there are much more published papers than with IPL (hematomas, lupus, warts, molluscum among others)
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