Treatment of cutaneous hemangiomas in preterm neonatal twins with the flashlamp-pumped pulsed dye laser

We report two cases of hemangiomas in twins born at a gestational age of 30 weeks who were treated with a flashlamp-pumped pulsed dye laser (FPDL) at 40 days postpartem. These were the youngest patients to our knowledge to be treated with FPDL.

Twin Caucasian females were born 10 weeks preterm. Twin A soon developed a 1 cm blanching erythematous patch with telangiectasia on a slightly bulbous nasal tip. Twin B developed a 6 mm erythematous papule on her forehead, a 12 x 10 cm erythematous plaque on her left shoulder, and two plaques measuring 2.5 x 2.0 cm and 1.5 x 1.0 cm on her right hip. The twins received seven monthly laser treatments.

Several of the hemangiomas showed remarkable regression, including the lesions which became ulcerated and healed on Twin B's left shoulder and right hip. No general or topical anesthesia was used and the twins tolerated the procedure well. No significant adverse effects were encountered. The maximum single treatment dose was 7 mm spot size, 5.0 J/cm2 and 186 pulses for twin B and 6.25 J/cm2 and 16 pulses for twin A.

To our knowledge, our patients are the youngest reported to be treated with FPDL at age 30 days preterm. Some of their hemangiomas responded, and no significant adverse effects were encountered. More prospective trials are needed to determine whether early treatment with FPDL accelerates regression of hemangiomas or results in a better cosmetic outcome than expectant treatment.