Angiokeratoma of the lower extremities: Successful treatment with a dual‐wavelength laser system (595 and 1064 nm)

Editor Angiokeratomas are rare vascular lesions with secondary verrucous epidermal changes. The exact pathogenesis is unknown, although genetic factors, pregnancy, chilblains, trauma and tissue asphyxia are known causal factors. We report for the first time on the successful treatment of ‘solitary and multiple papular’ type angiokeratomas of the lower extremities with a synchronized dual wavelength laser system (Cynergy with MultiplexTM, Cynosure, Westford, MA, USA). A 45-year-old male patient presented with multiple red-bluish pretibial verrucous plaques (Fig. 1). The lesions had been present since 10 years with recurrent episodes of bleeding and had been unsuccessfully treated with surgery resulting in significant scarring. A biopsy specimen was consistent with a diagnosis of ‘solitary and papular type’ angiokeratoma. The left side was treated with combined sequential application of 595-nm pulsed dye laser (PDL) and 1064-nm Nd:YAG wavelengths; the other received Nd:YAG treatment alone using the same parameters. Laser parameters were as follows: 10 J/cm2, 10 ms, 10-mm spot size with PDL, followed by Nd:YAG at 50 to 60 J/cm2, 15 ms with an interpulse delay of 500 ms. Treatments were repeated four times at 6-week intervals. Pulse overlap was avoided to minimize the risk of extensive thermal injury. Continuous air flow cooling was strictly adhered (Cryo5®, set at level 5, Zimmer Medizinsysteme GmbH, Neu-Ulm, Germany). At the end of the treatment course, we observed a more pronounced reduction of angiokeratomas on the side treated sequentially with the PDL and Nd:YAG wavelengths without further increase of pre-existing scars and other long-term side effects (Fig. 2). Angiokeratomas present a therapeutical challenge. They are often too widespread to allow surgery or cautery without haemorrhage and scarring. Numerous institutions have reported on the more or less successful treatment with argon laser, copper vapour laser, variable pulse width 532-nm KTP-Nd:YAG laser and PDL.1 In 2006, Lapidoth et al. treated 12 persons with ‘angiokeratomas of Fordyce’ with the PDL. Seven patients had an excellent response (clearance rate, 75–100%), and five patients had a good response (50–75%) with no permanent side effects.2 Despite its