Recent Advances in Vascular Laser Treatment: Devices, Drugs, Imaging, and Genetics

Conclusions

• Early treatment of port-wine capillary malformations appears safe and more effective than delayed intervention, with the best clearance seen when therapy begins in infancy.
• PDL remains the standard first-line laser for vascular lesions, but KTP is emerging as an equally effective option with less pain, purpura, and overall treatment discomfort.
• Larger spot sizes and pre/post-cooling improve patient tolerability in laser treatment without reducing efficacy.
• Photodynamic therapy with hemoporfin may be a powerful option for port-wine capillary malformations, especially across skin types, but it requires strict photosensitivity precautions and is still under active study.
• For infantile hemangiomas, beta-blockers such as propranolol are now clearly favored over watchful waiting, while topical timolol and maintenance laser can help prevent scarring and recurrence in selected cases.
• New topical and systemic drugs may help manage rosacea-related erythema and flushing, including oxymetazoline, brimonidine, and possibly erenumab.
• Trametinib shows promise for difficult arteriovenous malformations, suggesting that targeted medications may be useful where devices are less effective or potentially harmful.
• Imaging methods such as dermoscopy and optical coherence tomography may help predict which vascular lesions will respond poorly to laser treatment.
• Bigger vessel diameter and certain dermoscopic patterns are associated with poorer response to treatment in port-wine capillary malformations.
• Genetic and imaging markers may eventually help personalize treatment selection, but current data are not yet strong enough for definitive prediction.