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No Justification For Early Laser Treatment Of Uncomplicated Childhood Haemangiomas (pp 502, 521)

August 14, 2002

Early laser treatment of uncomplicated childhood haemangiomas (strawberry birthmarks) is no more beneficial than no intervention, conclude authors of a UK study in this week's issue of THE LANCET.

Childhood haemangiomas-the most common soft tissue tumours of infancy-occur in around 10% of children under one year of age. 90% of haemangiomas occur in the first month of life; they may continue to grow for six to eight months, most disappearing naturally by ten years of age. Although generally benign, haemangiomas can be complicated by ulceration, infection, bleeding and occlusion of vital structures. Lesions-especially on the face - may cause cosmetic disfigurement. A wait and see policy is often advised; however use of laser therapy (pulsed dye lasers [PDL]) has been introduced in recent years, although its effectiveness remains in doubt.

In a prospective, randomised controlled trial to assess the difference between a wait and see policy and PDL, Kapila Batta from Birmingham Children's Hospital, UK, and colleagues randomised 121 children aged between 1 and 14 weeks to receive either no treatment or PDL.   

The number of children whose lesions showed complete clearance or minimal residual signs at 1 year was not significantly different in the PDL treated and observation groups (42% and 44%, respectively). The number of children whose parents considered the haemangioma to be a problem at 1 year also did not differ much between groups (18% and 15%, respectively). However, 28% of infants treated with PDL had skin atrophy (thinning) compared with only 8% of children not treated. The incidence of complications was similar in the 2 groups. The only objective measure of resolution that improved with PDL treatment was haemangioma redness

Kapila Batta comments: "Our results do not show any useful benefit of early PDL treatment in uncomplicated haemangiomas. Furthermore, treated lesions are at increased risk of skin atrophy and hypopigmentation. The long-term results of this study are important, since 1 year may be too early to assess the benefit of early laser treatment."

In an accompanying Commentary (p 502), Ulrich Hohenleutner and Michael Landthaler from the University of Regensburg, Germany, praise Batta and colleagues for their 'carefully designed and meticulously done study' However they comment that a strategy of no intervention may not be as clear-cut when deciding to treat early angiomas in possibly complication-prone localisations. Ulrich Hohenleutner concludes: "Early treatment with laser therapy or cryotherapy is fast, simple, minimally invasive, and has a low side-effect rate. Clearly, in some (or perhaps many) lesions the treatment is superfluous, and other lesions will progress despite therapy. According to our results, however, treatment causes no harm, and 87% of parents would choose laser treatment again for their children. In our opinion, until we have effective treatments, which may not be so far away (antiangiogenic drugs or factors), we should continue laser (or cryo) treatment in possibly problematic early lesions. If disfigurement or other complication can be avoided or amended in even a small number of children, we believe treatment is worth a try."

Lancet