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Cubiró X, Garcia-Melendo C, Morales-Munera CE, Riera-Mestre A, Torres-Iglesias R, Villanueva B, Puig L, Baselga E. Comparative Treatment of Mucocutaneous Lesions in Hereditary Haemorrhagic Telangiectasia Patients With Dual Sequential Pulsed Dye Laser and Neodymium: Yttrium-Aluminium-Garnet Versus Neodymium: Yttrium-Aluminium-Garnet Laser Alone: A Double-Blind Randomized Controlled Study With Quality-of-Life Evaluation. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:246-257. [PMID: 37913989 DOI: 10.1016/j.ad.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Hereditary haemorrhagic telangiectasia (HHT) is characterized by the presence of telangiectases and larger arteriovenous malformations in different organs. Mucocutaneous telangiectases can bleed and become an aesthetic concern, impairing quality of life (QoL). However, the best treatment approach has not been defined yet. OBJECTIVE To evaluate the efficacy and safety of dual wavelength sequential 595/1064nm laser (DWSL) compared to 1064nm laser (Nd:YAG) alone. Secondarily, to evaluate QoL impairment in HHT patients, and its improvement with laser therapy. METHODS A comparative randomized split-body double-blinded prospective study (DWSL vs Nd:YAG). Demographic, clinical and treatment characteristics were recorded. The severity and degree of improvement were evaluated by three blinded examiners who scored pre-treatment and post-treatment pictures on a 5-point scale. Patients fulfilled Skindex-29 and FACE-Q® tests and assessed procedure-associated pain and patient satisfaction. RESULTS 111 treatment areas (55 treated with DWSL and 56 with Nd:YAG) from 26 patients were analyzed. The median number of laser sessions was 2 (interquartile range [IQR] 2-4; mean 2.90 vs 2.88, respectively). The median improvement score, irrespective of location, was significantly higher for Nd:YAG compared to DWSL: 3 (IQR 2-3; mean 2.61) vs 2 (IQR 2-3; mean 2.32), p=0.031. Both FACE-Q index and Skindex-29 test results improved significantly (p<0.001), and 92.4% patients reported a high degree of satisfaction (≥8). No severe adverse events were reported. CONCLUSIONS DWSL and Nd:YAG laser are convenient, safe and effective treatment options for mucocutaneous telangiectases in HHT patients. However, Nd:YAG delivered better results with better tolerability. QoL was significantly improved by both treatments.
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Affiliation(s)
- X Cubiró
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Hospital de Mollet, Mollet del Vallès, Barcelona, Spain.
| | - C Garcia-Melendo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - C E Morales-Munera
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Riera-Mestre
- Hereditary Hemorrhagic Telangiectasia Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - R Torres-Iglesias
- Hereditary Hemorrhagic Telangiectasia Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - B Villanueva
- Hereditary Hemorrhagic Telangiectasia Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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Cubiró X, Garcia-Melendo C, Morales-Munera CE, Riera-Mestre A, Torres-Iglesias R, Villanueva B, Puig L, Baselga E. Comparative Treatment of Mucocutaneous Lesions in Hereditary Haemorrhagic Telangiectasia Patients With Dual Sequential Pulsed Dye Laser and Neodymium: Yttrium-Aluminium-Garnet Versus Neodymium: Yttrium-Aluminium-Garnet Laser Alone: A Double-Blind Randomized Controlled Study With Quality-of-Life Evaluation. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T246-T257. [PMID: 38185205 DOI: 10.1016/j.ad.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/16/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Hereditary haemorrhagic telangiectasia (HHT) is characterized by the presence of telangiectases and larger arteriovenous malformations in different organs. Mucocutaneous telangiectases can bleed and become an aesthetic concern, impairing quality of life (QoL). However, the best treatment approach has not been defined yet. OBJECTIVE To evaluate the efficacy and safety of dual wavelength sequential 595/1064nm laser (DWSL) compared to 1064nm laser (Nd:YAG) alone. Secondarily, to evaluate QoL impairment in HHT patients, and its improvement with laser therapy. METHODS A comparative randomized split-body double-blinded prospective study (DWSL vs Nd:YAG). Demographic, clinical and treatment characteristics were recorded. The severity and degree of improvement were evaluated by three blinded examiners who scored pre-treatment and post-treatment pictures on a 5-point scale. Patients fulfilled Skindex-29 and FACE-Q® tests and assessed procedure-associated pain and patient satisfaction. RESULTS 111 treatment areas (55 treated with DWSL and 56 with Nd:YAG) from 26 patients were analyzed. The median number of laser sessions was 2 (interquartile range [IQR] 2-4; mean 2.90 vs 2.88, respectively). The median improvement score, irrespective of location, was significantly higher for Nd:YAG compared to DWSL: 3 (IQR 2-3; mean 2.61) vs 2 (IQR 2-3; mean 2.32), p=0.031. Both FACE-Q index and Skindex-29 test results improved significantly (p<0.001), and 92.4% patients reported a high degree of satisfaction (≥8). No severe adverse events were reported. CONCLUSIONS DWSL and Nd:YAG laser are convenient, safe and effective treatment options for mucocutaneous telangiectases in HHT patients. However, Nd:YAG delivered better results with better tolerability. QoL was significantly improved by both treatments.
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Affiliation(s)
- X Cubiró
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; Department of Dermatology, Hospital de Mollet, Mollet del Vallès, Barcelona, España.
| | - C Garcia-Melendo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; Department of Dermatology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España
| | - C E Morales-Munera
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - A Riera-Mestre
- Hereditary Hemorrhagic Telangiectasia Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, España
| | - R Torres-Iglesias
- Hereditary Hemorrhagic Telangiectasia Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| | - B Villanueva
- Hereditary Hemorrhagic Telangiectasia Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - E Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; Department of Dermatology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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Cubiró X, Garcia-Melendo C, Morales-Munera CE, Roé-Crespo E, Riera-Mestre A, Mora-Luján JM, Iriarte A, Puig L, Baselga E. Satisfactory treatment of mucocutaneous lesions in hereditary hemorrhagic telangiectasia patients with dual pulsed dye laser and neodymium: yttrium-aluminum-garnet. Dermatol Ther 2021; 34:e15124. [PMID: 34486206 DOI: 10.1111/dth.15124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is characterized by telangiectasia and larger arteriovenous malformations (AVM) in different organs. Mucocutaneous telangiectasia can bleed and cause stigmatization, but the best treatment approach has not been defined yet. The aim of the study was to evaluate the efficacy and safety of dual pulsed dye laser and neodymium: yttrium-aluminum-garnet (PDL-Nd:YAG) laser treatment for mucocutaneous telangiectasia in HHT patients. It is a retrospective case series, where clinical files of all HHT patients treated with PDL-Nd:YAG laser at our Department between December 2010 and July 2019 were reviewed. Demographic, clinical, and treatment characteristics were recorded. The severity and degree of improvement were evaluated by three blinded examiners scoring pretreatment and posttreatment pictures on a 5-point scale. Patient satisfaction and procedure pain were assessed using an ordinal scale (0-10). Forty-three treatment areas from 26 patients were analyzed. Lesions were predominantly located on the lower lip and cheeks. The median number of laser sessions per patient was 3 (interquartile range [IQR] 2-4). The median global severity score at baseline was 2 and became 0 at endpoint (p < 0.0001), with a median improvement rate of 4 (IQR 3-4). All patients reported a high degree of satisfaction (median 9) and tolerable pain (median 5). In conclusion, dual PDL-Nd: YAG laser is a convenient, safe, and effective treatment option for mucocutaneous telangiectasia in HHT patients.
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Affiliation(s)
- Xavier Cubiró
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Garcia-Melendo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Caridad Elena Morales-Munera
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Roé-Crespo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Riera-Mestre
- Hereditary Hemorrhagic Telangiectasia Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - José María Mora-Luján
- Hereditary Hemorrhagic Telangiectasia Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Adriana Iriarte
- Hereditary Hemorrhagic Telangiectasia Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eulàlia Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Dermatology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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