Nd:YAG laser in association with pulsed dye laser for the tr
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A 15 years-old girl affected by PHACES syndrome. At the age of one, the patient underwent corrective surgery for aortic coarctation. Physical examination showed IH covering the left periocular region. Patient-reported that IH appeared two months after birth, it grew for the first year of life and only partially spontaneously regressed up to its current form. Cranial computed tomography documented the presence of angiomatous formation localized mainly on the lateral side of the eye which extended to the tear gland and to the ipsilateral eyelid region. Magnetic resonance angiography did not detect malformative alterations of the examined districts. Extracutaneous manifestations included headache, myopia, and glaucoma.

Informed consent regarding the possible risks such as scars, discoloration, or hyperpigmentation of the procedures and the use of photographs for scientific reasons was obtained. This study was approved by the ethical committee Calabria Centro with reference number 373/2019. Facial hemangioma was treated with 1,064 nm Nd: YAG laser Synchro Replay (Deka Medical Lasers, Italy )followed by 595-nm PDL Synchro VasQ (Deka Medical Lasers, Italy) the first used on telangiectasias and the second on the entire surface of the hemangioma respectively.

The parameters used were 2,5 mm spot size, fluence 100 J/cm2, pulse duration 7 ms for Nd: YAG laser, and 12 mm spot size, fluence 7 J/cm2, pulse duration 0,5 ms, repetition rate 0,6 Hz for PDL. The first session of Nd: YAG laser treatment was performed without prior application of a local anesthetic with follow-up and retouching after 40 days. The first treatment session with PDL, preceded by the application of topical anesthetic (Lidocaine/ Tetracaine cream), was performed 40 days after the treatment session with Nd: YAG laser. A total of three PDL treatment sessions, once every 2 months, and a single session of Nd: YAG laser were performed; the size and appearance of the IH gradually and slowly improved after each treatment session. Antibiotic cream was applied topically to the treated area after each session. During the laser treatment, no severe side effects were observed; transient purpura lasting less than 15 days occurred after PDL treatment sessions. Photographs were taken before and at the end of all treatments; the results were assessed by evaluating the reduction in IH size and classified as 0-25% (I), 26-50% (II), 51-75% (III), and 76-100% (IV). Postoperatively, the patient was seen at 4 weeks, and 6 months after the last treatment.

Four weeks after the last treatment, the hemangioma showed a strong improvement (IV) in size, thickness, and appearance, and the result remained stable after 6 months.