Treatment of telangiectasia macularis eruptiva perstans with the 585-nm flashlamp-pumped dye laser

BACKGROUND. Telangiectasia macularis eruptiva perstans (TMEP) is a form of cutaneous mastocytosis characterized by truncal telangiectases that are refractory to treatment. OBJECTIVE. The safety and efficacy of treating TMEP with laser surgery was tested in a patient with extensive truncal lesions. METHODS. The patient was treated with the 585-nm flashlamp-pumped dye laser. Diphenhydramine and ranitidine or doxepin were used pre- and postoperatively to block the effects of mast cell mediator release during surgery RESULTS. All treated cutaneous lesions resolved completely, without scarring, after one treatment. Approximately 70% of the truncal lesions recurred 14 months postoperatively. Doxepin provided the best mast cell mediator blockade. Postoperative biopsy of a treated lesion demonstrated focal dermal vascular fibrosis with minimal telangiectasia and upper level of normal numbers of mast cells on the biopsy. CONCLUSIONS. An excellent therapeutic result was obtained by treating TMEP with the 585-nm flashlamp-pumped dye laser, although the response was temporary. The therapeutic effect of the laser appears to be secondary to reduction of the vasculature with no apparent effect on the mast cells. Physicians treating TMEP with laser therapy must use proper H1 and H2 receptor blockade to avoid potential complications from laser-induced mediator release.