Background/Purpose: Cutaneous telangiectases commonly occur in systemic sclerosis (SSc) and are distressing for the patient due to their perceived unsightly appearance. The current standard treatment is pulsed dye laser (PDL) therapy which is effective but often painful and does not prevent re-occurrence. Side effects include transient bruising and hypopigmentation. Intense pulsed light (IPL) is a potential alternative treatment using short, high-energy pulses of white light to destroy telangiectases via photothermal effects. IPL causes minimal bruising and no additional side effects compared to PDL. Our aim was to carry out an intra-patient comparison of PDL and IPL treatment of SSc-related telangiectases to determine relative efficacy and tolerability.

Methods:

20 patients (median 58 (range 49-72) years; 1 male) with SSc and approximately bilaterally-symmetric areas (face or upper limb) of telangiectases were recruited (1 withdrew after baseline). Patients were randomised to PDL treatment on the left/right side, with IPL treatment on the other. Following patch test of treatments (week -2; no adverse reactions reported), patients attended 3 treatment sessions at weeks 0 (baseline), 4 and 8. Photographs, dermoscopy and laser Doppler (LD) images of the treatment area were recorded prior to each treatment. Post-treatment, patients returned at 16 weeks and 9 months for repeat imaging and assessment. Photographs were assessed by comparison with baseline/previous image on a standardised scoring scale (-2 “much worse” to +2 “much better”). Dermoscopy images were assessed in the same way as the photographs. Average perfusion for 3 cardinal lesions on each side was extracted from the LD imaging data. Statistical analysis was carried out in SPSS.

Results: Both PDL and IPL treatment resulted in clinical improvement at most time points (Table 1, mean score values positive), as assessed by photographs and dermoscopy. The exception was dermoscopy at the week 16/month 9comparison, which showed slight negative (PDL) or zero (IPL) mean scores suggestive of  worsening or neutral appearance of telangiectases. The differences between scores for PDL and IPL suggest that PDL was associated with greater treatment response. Analysis of LD images (ANOVA) showed no significant difference between PDL and IPL treatment response at any time point; however, when comparing baseline perfusion to that at Week 16 (paired-t test) significant differences were found for PDL (median [interquartile range]: baseline 3.3 [2.7-4.7], week 16 2.4 (1.5-3.2), p=0.009) but not IPL (baseline 3.4 [2.5-4.1], week 16 2.8 (1.9-3.1), p=0.053). There were no reported side effects with IPL; PDL caused transient bruising.

Conclusion:

1) IPL and PDL are both effective treatments of SSc-related telangiectases, as assessed in this intra-patient study by photographs and dermoscopy.

2) PDL therapy produces a greater treatment response than IPL; however IPL has fewer side effects.

Table 1.

	Comparison	IPL	PDL	p-value (IPL-PDL difference)
Photographs‡	Week 4 vs baseline (n=17)	1.2 (1.0, 1.4)	1.3 (1.0, 1.5)	0.56
	Week 8 vs baseline (n=16)	1.4 (1.1, 1.8)	1.5 (1.2, 1.8)	0.62
	Week 16 vs baseline (n=15)	1.4 (0.9, 1.8)	1.7 (1.4, 2.0)	*0.01
	Month 9 vs Week 16 (n=8)	0.3 (-0.2, 0.7)	0.3 (-0.1, 0.7)	0.80
Dermoscopy‡	Week 4 vs baseline (n=17)	0.6 (0.3, 0.8)	0.8 (0.6, 1.0)	*0.02
	Week 8 vs baseline (n=16)	0.7 (0.4, 0.9)	1.0 (0.8, 1.3)	*0.04
	Week 16 vs baseline (n=13)	0.8 (0.6, 1.1)	1.3 (1.0, 1.5)	*0.02
	Month 9 vs Week 16 (n=6)	-0.0 (-0.5, 0.5)	-0.3 (-0.6, 0.0)	0.22
‡ – mean score (95% C.I.), *p<0.05

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