Treatment of spider veins of the leg using a long-pulsed Nd:YAG laser (Versapulse) at 532 nm.

BACKGROUND AND OBJECTIVE Prior studies have shown improvement in leg telangiectasias using a long pulse, frequency-doubled nd:YAG laser at 532 nm. The following study, with longer follow-up, was undertaken to determine the effectiveness of this laser and incidence of side-effects from a single treatment for lower extremity telangiectasia of less than 1 mm in diameter. MATERIALS AND METHODS Ten patients of skin types I-III received a single treatment on each of 18 treatment sites. One to three passes were used on each vessel with a repetition rate of 2 Hz. Two energy fluences of 12 J/cm2 and 16 J/cm2 were compared. Patients were followed for 1 year with follow-up photographs taken, from which the percentage of vessel clearance and side-effects were rated. RESULTS Overall, 44% of patients had a greater than 50% clearance from a single treatment using the frequency-doubled Nd:YAG laser at 532 nm. The higher fluence of 16 J/cm2 showed a better response than the lower fluence of 12 J/cm2. Side-effects were more marked and were seen in more patients treated at 16 J/cm2 than at the 12 J/cm2 setting. Some 94% of patients had hyperpigmentation that took up to 6 months to resolve. One patient treated at 16 J/cm2 experienced blisters, crusts and scarring, which persisted for 1 year. There was further improvement from 6 months to 1 year in one-third of the treatment sites. CONCLUSION The long-pulsed Nd:YAG laser at 532 nm with a chilled sapphire tip can treat leg telangiectasias of 0.5 to 1.0 mm in diameter with greater than 50% clearance at 44% of sites with a single treatment. Higher fluences of 16 J/cm2 demonstrated a greater clearance, but also greater adverse effects, including atrophic scarring persisting for 1 year. Further clinical improvement was seen at 6-month to 1-year follow-ups.