Unilateral nevoid telangiectasia—response to long-pulsed Nd:YAG laser and pulsed dye laser: a case report

Unilateral nevoid telangiectasia (UNT) is a rare disease characterized by punctuate and stellate telangiectasias that follow dermatomal distribution.1 Its etiology remains elusive; no standard treatment currently exists. We describe a 14-year-old Asian female (skin type IV) with UNT, who underwent treatment with long-pulsed 1064-nm Nd:YAG laser and 595-nm pulsed dye laser for her disease. The patient came to our clinic with linearly arranged, punctate telangiectasias over right side of back, shoulder, and arm (Figure 1). The lesions appeared at the age of 10. The diagnosis of UNT was made based on the clinical manifestations and telangiectasias in superficial dermis (as shown on a histologic exam done previously at another hospital). Angioma serpiginosum is an important differential diagnosis of UNT in this case. Three sessions of treatment with long-pulsed 1064-nm Nd:YAG laser (GentleYAG Laser; Candela Laser, Wayland, MA, USA) were given with parameters (fluence-spot sizepulse width) of 240 J/cm2-3 mm-10 ms (first week), 240 J/ cm2-3 mm-10 ms (second week), and 280 J/cm2-3 mm-10 ms (third week). The interval between each session was 4 weeks. However, there was only slight improvement. Histologic exam performed 2 weeks after the third session revealed marked telangiectasias in papillary dermis (Figure 2). Next, two sessions of pulsed dye laser with 595 nm wavelength (Vbeam Perfecta; Candela Laser) were given with parameters of 13 J/cm2-7 mm-40 ms (fluence-spot sizepulse width) for both sessions. Significant lightening of lesions (> 90%) was observed after the second session (Figure 3). The only adverse reaction was transient purpura that lasted for approximately 2 weeks. There was no hypoor hyper-pigmentation after treatment. There are two forms of UNT, the rarer congenital form and the more common acquired form.2 Telangiectasia develops during puberty in most of the acquired cases, as in our patient. Several reports point out the systemic association of acquired UNT, such as hyperestrogenemia and chronic liver disease.2 In out patient, there was no evidence of high serum level of estrogen or hepatic disease. Both long-pulsed 1064-nm Nd:YAG laser and pulsed dye laser have been shown to be effective in treating vascular lesions.3,4 Major et al3 reported good response with the former for facial and leg telangiectasias. However, it does not seem to be a good treatment modality for UNT for the current case. One possible explanation is that while the 1064-nm Nd:YAG laser beam tends to penetrate to deeper dermis, due to its long wavelength and lesser absorption Figure 1 Clinical picture before treatment.