Pulsed Dye Laser for Cherry Angioma Treatment?

Question

For a moderate case of cherry angioma, how many pulsed dye laser sessions are recommended to see desired results (on average)? How long does the treatment last?

Richard H. Tholen, MD, FACS · Answer

The pulsed dye laser uses a 585nm (yellow) wavelength with a 450 microsecond pulse duration and high energies of 4-7 joules/cm2. Spot sizes are typically 5-10mm, quite a bit larger than most angiomas. These parameters are best for treating tiny blood vessels in the upper layers of the skin, NOT much-larger angiomas. This laser was developed  in the early 1980's for use on port wine stain capillary malformations. The energy dosage is calculated to destroy the (very tiny) vessels without having much thermal energy damage adjacent tissues. This wavelength is well absorbed by hemoglobin, so this laser works very nicely for Rosacea vessels also. (Not so well for spider veins, which are larger, like angiomas).

	Cherry angiomas are superficial enough (they are on the surface of the skin), but although they seem small, they are typically 1-3mm in size, substantially larger than the vessels optimally treated by the pulsed dye laser.

	Sure, you can use the smallest spot size with the pulsed dye laser, and you can crank up the energy so you really "pop" the tiny blood blister (angioma), but you really don't need a pulsed dye laser to do that. Any hot (tiny) poker will do, like a hyfrecator, cat's whisker electrocautery, or even freezing with liquid nitrogen. IPL works OK, but usually the large beam size, and the broadband energy (all wavelengths) are not concentrated enough to treat the angioma without potentially damaging the rest of the skin (which is why more than one treatment can be recommended).

	If you want to use the laser best suited (by its wavelength, spot size, and energy) for angiomas (not the one the doctor happens to own), you should use the KTP laser which is a 532nm (green) laser with a continuous (foot-pedal controlled shutter) beam in a 250 micron (1/4 of a mm) spot size. 0.4 to 0.6 watts delivers adequate power concentrated in this spot size to completely remove angiomas in one treatment. This wavelength is well-absorbed by hemoglobin (and melanin, so you can treat brown spots at the same time), the spot size is comparable to or smaller than the angioma, so energy is directed only where it is desired, not on adjacent skin as well, and the energy can be delivered to the end point of angioma removal--just enough for the tiny ones, a bit more for the medium ones, and more for the larger ones. Voila, they're gone--one treatment. Depending on the size of the area treated I charge $250- $400, and throw in a free touch-up in a month if desired. (Patients love it, and always find a few more!)

Gregory Turowski, MD, PhD, FACS · Answer

DioLite 532 nm laser is a quick, comfortable and effective treatment for cherry angiomas.  Only one treatment is usually necessery.  These lesions clear very nicely in about 10-14 days.

John L. Burns Jr., MD · Answer

The problem with hemangiomas or general "angiomas" is that these tend to be thicker lesions thich can penetrate below the level of the skin.  The pulsed dye laser will penetrate about 0.7mm into the skin which essentially treats only the top layers of the skin (epidermis and papillary dermis).  This is why it can be so difficult to treat these type of vascular lesions with a pulsed dye laser.

	A better option would be to combine the pulsed dye laser with a Nd:YAG laser which can penetrate about 10mm into the tissue, depending on the laser settings.  Because of the deeper penetration, the Nd:YAG can treat the deeper component of the lesion and give a better and more reliable result.

Raffy Karamanoukian, MD, FACS · Answer

There are several lasers that treat cherry angiomas, including the YAG laser and the PDL. Both target the blood vessels and hemoglobin within the vascular lesion, causing them to be destroyed.

William Groff, DO · Answer

The pulsed dye laser in considered the gold standard for treatment of vascular lesions like cherry angiomas. It has an excellent safety record and can remove cherry angiomas in one treatment, unless they are very large. Other choices include

Nd:YAG (Gentle YAG)
KTP lasers
IPL

Having used all of these devices, I recommend the pulsed dye laser or Nd:YAG.
Best of luck!
Dr. Groff

Nd:YAG  (Gentle YAG)
KTP lasers
IPL

Having used all of these devices, I recommend the pulsed dye laser or Nd:YAG.
Best of luck!
Dr. Groff

Will Richardson, MD · Answer

I have found in experience with various derivations of the pulsed dye laser over the years that these lesions do require more than one session and often times can be persistent when large. The pulse dye laser performs ideally in situations where there are "mats" of vessels superficially vs. raised, red lesions.  All things aside, this is my favorite laser on the market. Dr. Will

H.L. Greenberg, MD · Answer

At Las Vegas Dermatology we use the cynergy laser (pulsed dye/Nd:yag) laser to treat angiomas- it's a great therapy that usually requires 1-2 treatments.  The treated spots go away quickly leaving normal skin in their stead.  I have some really cool videos showing this therapy on our /lvderm youtube channel.

Daniel Berg, MD · Answer

Most cherry angiomas (little red spots on the skin that increase with age) respond very well to pulsed dye laser - typically one or two treatments.  The larger ones (> 5mm) can sometimes be more stubborn.

	Multiple spots can be treated at one visit - actually quite satisfying to treat usually because of the response rate with pretty low risk of complications.

Elizabeth F. Rostan, MD · Answer

For most small to medium (up to size of pencil eraser) just one treatment with the pulsed dye laser will effective for complete removal. Occasionally 2 treatments are needed and 2 treatments are more common for largercherry angiomas.

Stephen A. Goldstein, MD · Answer

Using a pulsed dye (YAG) laser is the preferred method of treatment for your cherry angioma. IPL (intense pulsed light) treatments also work extremely well in this case.  If the lesion is small, even a hyfrecator (a medical apparatus used to seal vessels) can give you desired results.  The number of treatments does depend on the size of complexity of the lesions.  As Dr. Lupton mentioned above, cherry angiomas usually do not reoccur once removed.  However, you may need additional treatments for other lesions in the future. 
 
Because of this, the best thing to do is establish a relationship with a board certified plastic surgeon who is experienced with these procedures Consult with him/her to choose the most appropriate treatment plan.  Good luck, and thank you for your question.

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