Laser Treatment for Birthmark No Better Than No Treatment

And it could actually increase risk of skin atrophy, British research contends

THURSDAY, Aug. 15, 2002 (HealthDayNews) -- Removing uncomplicated childhood hemangiomas, better known as strawberry birthmarks, with laser treatment appears to be no better than taking a wait-and-see approach.

And there may even be a downside to treating the trouble spots, says a new study in this week's issue of The Lancet. Treated lesions are at an increased risk of skin atrophy and hypopigmentation, or decrease in pigment production, the study authors contend.

The researchers had been hoping for a different result.

"We set out to prove that all hemangiomas could be cleared completely if treatment with pulsed dye laser (PDL) was started at the earliest flat stage. We were surprised and disappointed by our results," says Dr. Kapila Batta, the lead author of the study and a member of the department of dermatology at The Birmingham Children's Hospital in Birmingham, England.

Childhood hemangiomas occur in about 10 percent of children under the age of one. These tumors, made of abnormally dense groups of small blood vessels, are usually benign but can be complicated by ulceration, infection and bleeding. There's also the potential for cosmetic disfigurement, especially if the lesion is on the face.

Some parents and physicians opt for treatment by PDL, which removes the mark by destroying the abnormal blood vessels. While pulsed dye laser is an accepted and effective treatment for port-wine stains in children (that's what former Soviet president Mikhail Gorbachev has on his forehead), there's less consensus on what its role is for hemangiomas.

As a result, many prefer to wait. Most of the marks go away on their own, according to Dr. Lawrence Schachner, director of pediatric dermatology at the University of Miami School of Medicine. About 50 percent go away by the time the child is five, 70 percent by the time she is seven-years-old, and about 90 percent by the time she is nine.

The current study, which looked at 121 infants one to 14 weeks old all with early "uncomplicated" hemangiomas, found similar outcomes in the tiny patients at the end of one year.

One difference was that 28 percent of the babies treated with PDL had skin atrophy (thinning of the skin) compared with only 8 percent of children who were not treated.

Is the procedure a total wash? Definitely not, say many physicians.

"It gets the red out. You may gain something, and you may lose something," Schachner says. "Is there a role for laser in hemangiomas always? No. Is there a role sometimes? Probably yes."

Decisions need to be made on a case-by-case basis, say many experts.

PDL has the potential to stop the bleeding in ulcerated hemangiomas, Schachner says. It can also eliminate traces of redness in a birthmark that doesn't entirely disappear. It may also be useful for hemangiomas that are located in areas where they tend not to go away.

The idea of an "uncomplicated" hemangioma drew some ire from physicians.

"Who defines 'uncomplicated'?" asks Dr. Maritza Perez, director of cosmetic dermatology at St. Luke's-Roosevelt Hospital in New York City.

Perez's twin daughters developed strawberry birthmarks in the first few months of their lives. All the marks were superficial, but Perez opted to treat the daughter who had developed marks on the tip of her nose and on her scalp.

"It depends on what you call uncomplicated. From my point of view, if I allowed my daughter to have a deformed nose which would need plastic surgery, that's not uncomplicated," she says.

Perez did not treat her other daughter, who had a mark in a less conspicuous spot.

Perez is also concerned about the findings regarding atrophy. Other studies, she says, have found an extremely small incidence of atrophy with PDL.

What To Do

For more information on "strawberry birthmarks," visit the Vascular Birthmarks Foundation. For discussion on the differences between the various vascular birthmarks, check out the American Academy of Dermatology.

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