Unilateral Nevoid Telangiectasia Treated With Pulsed Dye Laser: Use of Dermoscopy to Monitor the Response
Imagine noticing tiny red blood vessels spreading slowly across your child’s arm—uneven, noticeable, and growing over years. For one 12-year-old girl, this was the reality of unilateral nevoid telangiectasia (UNT), a rare vascular skin condition that can cause significant cosmetic distress. But thanks to a combination of pulsed dye laser (PDL) therapy and a simple, non-invasive tool called dermoscopy, her story ended with clear skin and relief.
What Is UNT?
UNT is a rare skin condition marked by telangiectasia—tiny, dilated blood vessels close to the skin’s surface—that form a linear (straight or curved) pattern on one side of the body. It can be present at birth (congenital) or develop later (acquired). The acquired type is often linked to high estrogen levels—think puberty, pregnancy, oral contraceptives, or chronic liver disease—though doctors still don’t fully understand why some people get it. For many patients, the biggest concern is how the vessels look: visible, uneven, and hard to cover, which can take a toll on self-esteem.
PDL: A Targeted Treatment for Vascular Lesions
PDL is a gold-standard treatment for vascular skin issues like port-wine stains (PWS) or spider angiomas. It works through selective photothermolysis—a technique that targets hemoglobin (the red protein in blood) in abnormal vessels. The laser’s heat destroys these vessels without harming surrounding skin, minimizing scarring or side effects. Previous research, like a 2010 study by Sharma and Khandpur, found that 5 out of 6 UNT patients saw good to excellent results after 2–5 PDL sessions.
The Case: A 12-Year-Old Girl’s Journey
The girl in this study first noticed telangiectasia on her right arm at age 8. Over four years, the vessels multiplied—small, red, and impossible to ignore. When she visited the Department of Dermatology at Union Hospital (Tongji Medical College, Huazhong University of Science and Technology), her doctors used two tools to guide treatment:
- Dermoscopy: A handheld device that magnifies the skin’s surface (like a high-tech magnifying glass). It revealed dozens of small “red-dotted” and “globular” vessels—patterns that signal shallow vessels (ideal for PDL, which targets surface lesions).
- Reflectance Confocal Microscopy (RCM): A non-invasive tool that lets doctors see inside the skin’s layers. It showed dilated vessels in the dermal papillae (tiny skin bumps) with blood cells flowing through—confirmation of abnormal growth.
Treatment: Three PDL Sessions and Real-Time Monitoring
The team used a fast-lamp tunable PDL (Cynosure VLS) with these parameters:
- Spot size: 7 mm (precise coverage for small areas)
- Fluence: 7.5–8.5 J/cm² (adjusted energy to avoid damage)
- Pulse duration: 0.5 ms (quick pulses to protect skin)
- Air cooling (Cryo 5) to reduce pain and swelling.
Before each session, the girl’s arm was numbed with a cream (2.5% lignocaine + 2.5% prilocaine) for an hour to keep her comfortable.
Immediate and Long-Term Results
Right after the first session, the treated area turned red (erythema) and developed purple spots (purpura)—signs the laser had damaged abnormal vessels. Dermoscopy showed a “reddish background” (from leaked blood cells), and RCM confirmed capillary thrombosis (clotted vessels)—exactly what doctors wanted.
- After 1 session: 80% of the vessels were gone.
- After 2 sessions: Almost all vessels cleared, though tiny dots remained (seen only with dermoscopy).
- After 3 sessions: The skin was completely clear. A mild, oval-shaped hyperpigmentation (dark spot) remained—common with PDL and usually fades over time.
The girl and her family were thrilled: no more visible vessels, no pain, and a simple plan that worked.
Why Dermoscopy Was a Game-Changer
Dermoscopy isn’t just a magnifying glass—it’s a predictive and monitoring tool. For UNT, the “dotted/globular” vessel pattern (seen here) tells doctors the vessels are shallow—perfect for PDL. It also let the team track progress between sessions: after two treatments, dermoscopy showed tiny remaining vessels, so they knew a third session was needed to finish the job.
This aligns with research on port-wine stains: a 2019 study by Kwiek et al. found that dotted/globular patterns predict better PDL results, while “web-like” (reticular) patterns are harder to treat. For this girl, dermoscopy didn’t just monitor—it guided the treatment to success.
Conclusion: Hope for Rare Skin Conditions
UNT is rare, but its impact on quality of life is real. This case shows that PDL—when paired with tools like dermoscopy—can deliver exceptional results. For patients (and parents) dealing with visible skin conditions, it’s a reminder that even rare issues have solutions—and that non-invasive tools can make treatment safer and more effective.
The study was led by Xiang-Jie An, Jing Yang, Yao-Ying Gao, Yan Li, and Juan Tao from the Department of Dermatology at Union Hospital (Tongji Medical College, Huazhong University of Science and Technology). It was funded by the National Natural Science Foundation of China (No. 81602760) and published in the Chinese Medical Journal in 2019.
References
- Wenson SF, Jan F, Sepehr A. Unilateral nevoid telangiectasia syndrome: a case report and review of the literature. Dermatol Online J 2011;17:2. doi: 10.1111/j.1600-0560.2010.01629.x.
- Božidar Z, Župančić B. Pulsed dye laser treatment of vascular lesions in childhood. Acta Dermatovenerol Croat 2010;18:201–208. doi: 10.2340/00015555.0860.
- Sharma VK, Khandpur S. Unilateral nevoid telangiectasia – response to pulsed dye laser. Int J Dermatol 2010;45:960–964. doi: 10.1111/j.1365-4632.2006.02862.x.
- Oliveira A, Glória Velho, Sanches M, Selores M. Unilateral nevoid telangiectasia – report of two cases. Int J Dermatol 2013;53:e32–e33. doi: 10.1111/j.1365-4632.2011.05457.x.
- Kwiek B, Rozalski M, Sieczych J, Paluch Ł, Kowalewski C, Ambroziak M. Predictive value of dermoscopy for the treatment of port-wine stains with large spot 532nm laser. Lasers Surg Med 2019;3:1–15. doi: 10.1002/lsm.23083.
doi.org/10.1097/CM9.0000000000000397
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