Intense pulsed light vs. long-pulsed dye laser treatment of telangiectasia after radiotherapy for breast cancer: a randomized split-lesion trial of two different treatments

• Published in: British journal of dermatology (1951) Vol. 160; no. 6; pp. 1237 - 1241
• Main Authors: Nymann, P., Hedelund, L., Hædersdal, M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.06.2009; Wiley-Blackwell
• Subjects: Adult; adverse effects; Biological and medical sciences; breast neoplasms; Breast Neoplasms - radiotherapy; Dermatology; Female; Gynecology. Andrology. Obstetrics; Humans; Injuries of the skin. Diseases of the skin due to physical agents; Lasers, Dye - therapeutic use; Mammary gland diseases; Medical sciences; Middle Aged; pain; Phototherapy - methods; radiodermatitis; Radiodermatitis - etiology; Radiodermatitis - therapy; telangiectasia; Telangiectasis - therapy; Traumas. Diseases due to physical agents; Tumors; Vascular disorders of the skin; Skin disease; Radiodermatitis; Breast disease; Dermatology; Toxicity; Breast tumor; breast neoplasms; Cardiovascular disease; Breast cancer; Malignant tumor; Radiotherapy; Telangiectasia; Vascular disease; Mammary gland diseases; Pain; Physical agent; Radiation injury; adverse effects; Lesion; Comparative study; Cancer
• ISSN: 0007-0963; 1365-2133; 1365-2133
• DOI: 10.1111/j.1365-2133.2009.09104.x

Summary Background  Chronic radiodermatitis is a common sequela of treatment for breast cancer and potentially a psychologically distressing factor for the affected women. Objectives  To evaluate the efficacy and adverse effects of treatments with a long‐pulsed dye laser (LPDL) vs. intense pulsed light (IPL) in a randomized split‐lesion trial. Methods  Thirteen female volunteers with radiodermatitis and Fitzpatrick skin types II–III were included in the study. Subjects received a series of three treatments at 6‐week intervals with half‐lesion LPDL (V‐beam Perfecta, 595 nm) and half‐lesion IPL (Ellipse Flex); the interventions were randomly assigned to left/right or upper/lower halves. Primary end‐points were reduction in telangiectasia, patient satisfaction and preferred treatment. Secondary end‐points were pain and adverse effects. Efficacy was registered by blinded photographic evaluations 3 months after the final treatment. Results  Eleven patients completed the study. Telangiectasia cleared with both treatments but the efficacy of LPDL was superior. Blinded photographic evaluations showed median vessel clearances of 90% (LPDL) and 50% (IPL) (P = 0·01). LPDL treatments were associated with lower pain scores than IPL treatments [median visual analogue scale (VAS) score 4·3 and 6·0, respectively, P < 0·01]. Patients were slightly more satisfied with LPDL (median VAS score 8) than IPL treatments (median VAS score 7; P < 0·05) and more preferred LPDL (n = 9) to IPL (n = 2) (P < 0·01). Two patients withdrew from the study because of hypopigmentation of the IPL treated areas, which slowly repigmented within 1 year. Conclusions  This study was based on two specific laser and IPL devices, and found the LPDL treatment to be advantageous compared with IPL due to superior vessel clearance and less pain.