Vascular and Pigmented Lesions

What conditions are treated with lasers/energy-based devices? 

Lasers used to treat vascular lesions are capable of treating a variety of birthmarks, dilated vessels such as those seen after chronic sun exposure or in medical conditions such as rosacea, red noses, red cheeks, vascular growths such as hemangiomas, and red scars.

Using different wavelengths, the same concept may be applied to the treatment of pigmented lesions. Lasers with a pulse duration of 1 billionth of a second are quite effective in treating many pigmented lesions, such as a variety of brown or black birthmarks, sun-induced freckle-like pigmentation, café-au-lait birthmarks, and traumatic or decorative tattoos. Lesions may disappear entirely or require a series of treatments, and there are rarely any textural, pigmentary, or scarring changes associated with this.

What devices are used to treat these conditions? 

The classic example of therapy is the use of pulsed dye lasers (PDL) in the treatment of vascular lesions such as port wine birthmarks. The concept underlying the development of all of the lasers was generated in an effort to better treat the vascular birthmarks seen in children. The intense yellow light of this laser is selectively absorbed by the red color of blood suffusing the birthmark, selectively damaging these vessels and inducing the port wine birthmark to gradually fade.

Other devices commonly used to treat vascular and pigmented lesions include, but are not limited to, KTP and Q-Switched (QS) or picosecond Nd:YAG lasers, and IPL (Intense Pulsed Light). 

Description of treatment

The unique properties of laser light allow specific targets within the skin to be damaged or destroyed, leaving surrounding normal tissues unaffected. The concept of all state-of-the-art lasers and light sources is based on the principle of selective destruction of specific targets within the skin with minimal damage to surrounding structures. Such damage occurs by selecting a wavelength of light that is maximally absorbed by the targeted structure in a very short duration of the light pulse. This conceptual breakthrough has revolutionized the treatment of a large variety of cutaneous disorders. 

The ability to target blood vessels, different types of vascular and pigmented birthmarks, and areas of abnormal pigmentation became a reality only with the discovery and use of lasers and other light sources and their ability to bring about almost magical changes in the skin.

Success rates/potential complications

Often, treatment approaches are based on the patient’s skin type. With certain conditions or skin types, there is a higher potential for complications. It is very important for the patient to do homework upfront to find a practitioner with the skills and experience to perform the treatment.  

What outcome should patients expect? 

Depending on the condition, lesions may disappear entirely after 1-2 treatments or may require a series of treatments. It is important that the patient follow post-operative care guidelines, such as limiting sun exposure along with regular application of broad-spectrum sunscreen.  

Updated October 9, 2024

Vascular Birthmark Guidelines

One of the chief complaints by affected families is the lack of access to proper care, and insurance denial for necessary treatment. ASLMS has forged a partnership with the Vascular Birthmark Foundation (VBF) to create much-needed consensus guidelines to optimize laser treatments of cutaneous vascular anomalies. Click the image to view the consensus guidelines. 

For Professionals - Learn more about the Vascular Birthmark Consensus Guidelines Resources available through the ASLMS Online Learning Center.