PRAGUE – Optimized pulsed light therapy using Palomar Medical Technologies’ proprietary MaxG handpiece proved safe and efficient for the treatment of port wine stains and capillary malformations in an open study.
The MaxG is next-generation intense pulsed light therapy. The advance lies in a handpiece optimized so as to use a dual-band spectrum with two peaks: one at 500-670 nm and another at 870-1,200 nm. The peak in the visible light range targets small, superficial vessels, while the one in the near infrared addresses deeper vessels. Thus, optimized pulsed light (OPL) is able to achieve uniform heating and pulse width matched to a target vessel’s depth and size, Dr. Maurice A. Adatto explained at the annual congress of the European Academy of Dermatology and Venereology.
For years, pulsed dye laser therapy has been considered the gold standard in the treatment of vascular lesions. But recent published data demonstrate that while the laser can coagulate vessels quite nicely at the surface, the coagulation isn’t nearly as good for deeper vessels. In animal models, the OPL achieves greater increases in temperature compared with the pulsed dye laser at the purpuric threshold fluence in deeper and larger capillaries, said Dr. Adatto, who is medical director of the SkinPulse Dermatology & Laser Center in Geneva.
Dr. Adatto presented a two-center series of 16 OPL-treated adults and adolescents with vascular lesions on the face, neck, trunk, and lower limbs. The procedures were performed by him at the center in Geneva, and by his coinvestigator Dr. David Friedman in Jerusalem. The OPL handpiece was attached to Palomar’s Icon intense pulsed light device.
Outcomes were objectively assessed using the Antera 3D camera, made by Miravex, which provides high-definition clinical photographs along with quantitative measurement of hemoglobin and melanin clearance in treated areas. Assessments were done at 2-4 days and 1-2 months post-treatment.
The efficacy was impressive, and the side effects were far milder and more transitory than can occur with pulsed dye laser therapy, according to the dermatologist.
The majority of patients – 10 of 16 – achieved 50% or greater improvement in one to four OPL sessions. After the first treatment, four patients had roughly a 20% improvement, five were 25%-49% better, three showed 50%-74% clearance, and two patients showed 80% and 100% clearance.
Side effects consisted of 3-5 days of purpura and 1-3 days of local edema. To date, OPL for vascular lesions hasn’t resulted in any scars or in hypo- or hyperpigmentation.
As for the technical details, Dr. Adatto utilized one pass with 50 J/cm2 at 10 ms, while Dr. Friedman used a two-pass technique: the first at 34-36 J/cm2 at 10 ms, followed by a second at 22-28 J/cm2 at 5 ms. Treatment sessions were carried out at 4- to 6-week intervals.
In response to audience questions, Dr. Adatto said that his anecdotal experience has been that once a patient achieves greater than about 50% improvement, be it with a single OPL treatment session or after three, the therapeutic gain of additional sessions is smaller than with the initial ones.
"You can gain another 10% or so with another session for someone who has 70% improvement, but that’s it. You will reach a plateau," he said.
Dr. Adatto is now planning a similar study using OPL to treat vascular lesions in a pediatric population.
The study was funded by Palomar Medical Technologies. Dr. Adatto has received research funds from and is an adviser to Palomar and numerous other laser and intense pulsed light device manufacturers.