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Laser and light therapy for cutaneous vascular lesions

Kristen M Kelly, MD
Section Editors
Jeffrey S Dover, MD, FRCPC
Moise L Levy, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Lasers and intense pulsed light (IPL) are used for the treatment of multiple cutaneous vascular lesions including telangiectasias, port wine stains (PWS), and infantile hemangiomas. During treatment, the absorption of light energy by intravascular oxyhemoglobin leads to heating and coagulation of lesional blood vessels. The responses of vascular lesions to therapy are influenced by the type of light source used, the clinical characteristics of the target lesion, and patient-specific factors (eg, skin color, patient age).

Although laser and IPL therapy can result in clinical benefits, treatment is not innocuous. Cutaneous and ocular damage can occur if clinicians are not vigilant. The use of appropriate equipment settings, skin cooling mechanisms, and other safety measures minimize the occurrence of adverse events due to treatment.

The types of lasers used in the treatment of vascular lesions as well as the efficacy and clinical use of lasers for the treatment of PWS, hemangiomas, and telangiectasias will be discussed here. The general principles of medical lasers, the principles of light therapy for the treatment of skin, and laser and light therapy for lower extremity telangiectasias and veins are reviewed elsewhere. (See "Basic principles of medical lasers" and "Principles of laser and intense pulsed light for cutaneous lesions".)


The theory of selective photothermolysis describes the method through which lasers or intense pulsed light (IPL) can be used to selectively destroy specific targets in the skin while minimizing damage to other cutaneous structures [1]. In concordance with this theory, light energy must be delivered in a manner that results in preferential absorption of light by light-absorbing molecules (chromophores) located within the target. The absorption of light energy by chromophores leads to heating and coagulation of the target. In order to limit collateral damage, the diffusion of heat to adjacent tissues must also be minimized. The principles of laser and light therapy for cutaneous lesions are reviewed in greater detail elsewhere. (See "Principles of laser and intense pulsed light for cutaneous lesions".)

The major chromophore targeted during therapy of vascular lesions is generally oxyhemoglobin, although absorption by other hemoglobin species including deoxyhemoglobin and methemoglobin can also occur. Significant light absorption by oxyhemoglobin occurs in the range of yellow and green light; peak absorption occurs at 418, 542, and 577 nm [1]. A lower peak of light absorption by oxyhemoglobin occurs in the near-infrared light range. Thus, lasers that emit wavelengths of light near the primary absorption peaks of oxyhemoglobin, such as the 585 or 595 nm pulsed dye and the 532 nm frequency-doubled neodymium:yttrium aluminum garnet (Nd:YAG) lasers, are often favored for the treatment of vascular lesions. Infrared-range lasers (1064 nm Nd:YAG, alexandrite, or diode) can also be effective for this indication, but are associated with a greater risk for tissue damage and ulceration.

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Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2016.
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