Effects of long-pulsed 1064-nm Nd:YAG laser on telangiectasias and reticular veins: a human in-vivo histological study.

BACKGROUND: Telangiectasias and reticular veins are associated with aesthetic disorders. Sclerotherapy is the gold standard treatment, but long-pulsed 1064-nm Nd:YAG laser (LP1064 laser) is also used. No data on the human histological effects of these lasers are reported. The objective was to test different LP1064 laser parameters and their histological effects on the dermis, collagen, telangiectasias, and reticular veins. METHODS: This was a single-center, prospective, single-arm, case-control, human study. During surgery (dermolipectomy), the abdominal section of 10 female patients was irradiated with 6 different transdermal LP1064 laser parameters after anesthesia. Ten pieces with areas of varying irradiation were evaluated according to the characteristics of the vessels identified by area. In each piece, two irradiation areas were performed per group, totaling 12 irradiation areas per piece, with 120 regions later analyzed at the end of the ten samples. After removing the surgical product, histological sections were extracted, and the dermis, telangiectasias, and reticular veins were analyzed. RESULTS: Histological analysis showed that exposition to six different parameters from LP1064 laser led to significant dermal layer separation and collagen alterations. The effects were inconsistent on the loss of endothelial cells, intravascular thrombus formation, and fusion of vascular walls for both telangiectasias and reticular veins. In reticular veins, effects on intravascular thrombus formation and vascular wall fusion were not observed. CONCLUSIONS: The LP1064 laser in monotherapy with fixed settings did not lead to a consistent vascular lesion to promote immediate occlusion in telangiectasias and reticular veins. This strategy may not work as monotherapy for small vein treatment, but the possible late response to the LP1064 laser cannot be ruled out and require further investigation.

The impact of dermatoscopy on the pretreatment assessment of lower limbs telangiectasias: a prospective study.

BACKGROUND: Telangiectasias treatment can lead to skin hyperpigmentation, and pretreatment evaluation with dermoscopy was never performed. This study aimed to evaluate the applicability of dermatoscopy before telangiectasias treatment. METHODS: A prospective study evaluating patients of both sexes (18 to 60 years old), with telangiectasias (venous disease C2-C3 CEAP) of the lower limbs treated at outpatient clinics. Subjects who had never undergone previous interventional treatment for CVI and Fitzpatrick Classification up to phototype III, were included. Patients were submitted to both naked and dermoscopy evaluations of their skin and blindly evaluated by three vascular surgeons and an experienced dermatologist. Agreement by naked eye versus dermoscopy and among examiners was performed using Kappa correlation. Agreement by naked eye among patients and the examiners consensus were performed. RESULTS: There was a more significant agreement between the most experienced examiners in the naked eye assessment. With the dermatoscopic device, the highest agreement was maintained among the more experienced examiners, with a predominance of choice of the purple pigment in 29 of the 38 limbs, which represents a simple agreement of 76.3% (95% CI: 62.8-89.8%) with a Kappa concordance Index of 0.178. There was an agreement between the patient and the consensus of the naked eye examiners in 41.2% (95% CI: 24.7-57.7%). CONCLUSIONS: The dermatoscopy was not decisive for diagnosing skin pigmentation in areas of telangiectasia that had never been treated. The diagnostic accuracy was directly related to the clinical experience of the examiner. Dermatoscopy did not help in aligning expectations with treatment between physicians and patients.