Diagnosis and Management of Infantile Hemangioma

Table 31. Harms/adverse effects in comparative studies of lasers to treat * IH
Intervention
Harm/Adverse Event
N Studies Reporting Harm
Reported Rates
(# Participants With
Across Studies
Harm/Total Participants)
Pulsed dye laser Purpura 215 1 (25/25) 100%
Swelling 215 1 (25/25 100%
Skin atrophy 212 1 (17/60) 28%
Minimal crusting 210 1 (2/11) 18.2%
Ulceration 212 1 (4/60) 7%
Painful ulceration 212 1 (3/60) 5%
Ulcer formation 211 1 (1/26) 4%
Bleeding 212 1 (2/60) 3%
Infection 212 1 (2/60) 3%
** Atrophic scarring 150,215 1 (2/42) 3%-6%
Hyperpigmentation 211,213,215 3 (12/66) 13%-20%
Texture change 211,213 2 (8/41) 13%-23%
Hypopigmentation 211-213,215 4 (41/126) 10%-45%
Blistering (crusts and blisters) 213,215 2 (21/40) 13%-76%
Longer pulse PDL Hypopigmentation 211,213 2 (4/34) 12%-12.5%
Hyperpigmentation 211,213 2 (3/34) 8%-12.5%
Texture change 211,213 2 (2/34) 4%-12.5%
Nd:YAG laser *** Hypopigmentation 215 1 (2/25) 6%
Purpura 215 1 (5/25) 20%
Crusts and blisters 215 1 (8/25) 24%
Swelling 215 1 (25/25 100%
Atrophic scarring 215 1 (1/25) 3%
Scarring 217 1 (8/26) 30.8%
Delayed healing 217 1 (1/26) 12.5%
Postoperative bleeding 217 1 (2/26) 7.7%
Postoperative complications 1(35/235) 14.9%
(including bleeding, atrophic scars
and hypertrophic scars) 218
Argon laser Delayed healing 217 1 (2/31) 13%
Postoperative bleeding 217 1 (1/31) 3.2%
Reaction to local anesthesia 1 (1/31) 3.2%
(seizure and hospitalization) 217
Observation Hypopigmentation 212 1 (9/61) 15%
Skin atrophy 212 1 (5/61) 8%
Ulceration 212 1 (4/61) 7%
Painful ulceration 212 1 (2/61) 3%
Bleeding 212 1 (2/61) 3%
Infection 212 1 (4/61) 7%
IH = infantile hemangioma; n = number; Nd:YAG = neodymium yttrium aluminum garnet; PDL = pulsed dye laser
* One study of cryosurgery reported harms by number of IH. Scarring occurred in 4/17 treated IH and on 1 untreated IH. 220
**
One study reported atrophic scarring and ulceration in 1/17 children receiving PDL and concurrent propranolol. 150 One study
(not represented in table) reported that 12.4% of the parents of 11 children receiving PDL judged that the treatment was painful.
Another study included followup at 5 years post-PDL or observation and noted more scarring in the PDL group (49% vs 28% in
controls, p=0.02 and more hypopigmentation (44% vs 23% in observation group, p=0.03). The number with skin atrophy was
similar between groups. 212,250
r*** One cohort study comparing topical timolol with PDL plus Nd:YAG laser reported crusting and hyperpigmentation in 4/30
children. 14 Another study comparing topical timolol plus PDL to timolol alone reported that no children experienced any adverse
effects. 106
Ten case series reported on 1785 children who were treated with PDL (Table 32). One
Korean study (good quality for harms reporting) treated 47 superficial or mixed IH in 40 patients
monitored for hyper- and hypo- pigmentation, skin atrophy, hypertrophic scarring, and ulceration
during treatment. 223 The only adverse event noted in this study was hyperpigmentation in two
patients with superficial IH. The final assessment in this study was at the end of treatment so no
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