Comparative evaluation of long-pulsed Nd: YAG and pulsed dye lasers in the treatment of venous lake lesions: a prospective clinical study

Venous lakes (VL) are benign vascular malformations found mainly on the lips and face. Various treatment modalities have been proposed, with laser therapy emerging as an effective and minimally invasive option. This study aimed to compare the efficacy and safety of a long-pulsed neodymium-doped yttrium aluminium garnet (Nd: YAG) laser and a pulsed dye laser (PDL) in the treatment of VLs. A total of 23 patients with VL lesions were treated using pulsed dye laser (PDL; n = 8) or Nd: YAG laser ( n = 15), with sessions at 6-week intervals. Data on patient demographics, lesion characteristics, treatment parameters, and outcomes were collected. Two experienced dermatologists evaluated treatment effectiveness by comparing pre- and post-treatment images, focusing on reductions in lesion size and improvements in color. The mean age of the participants was 48.8 ± 12.3 years, and the mean number of treatment sessions was 3.17 ± 1.02. Overall, lesion size decreased significantly from 1.14 ± 0.71 to 0.53 ± 0.72 cm ( P < 0.001), corresponding to a mean relative reduction of 58.3%, while mean color improvement was 65.2%. A ≥ 75% reduction in lesion size was achieved in 39.1% of patients and was more frequent with Nd: YAG than with PDL (53.3% vs. 12.5% ). A ≥ 75% improvement in lesion color occurred significantly more often with Nd: YAG (60.0% vs. 0%, P = 0.007). Complete clearance was observed in 17.4% of patients, all of whom were treated with Nd: YAG. Mean absolute lesion size reduction was greater with Nd: YAG than with PDL (0.68 ± 0.34 vs. 0.40 ± 0.30 cm), although the difference was not statistically significant, whereas mean color improvement was significantly greater with Nd: YAG (0.75 ± 0.27 vs. 0.46 ± 0.19; P = 0.007). Treatment was generally well tolerated, with one case of post-treatment scarring. Nd: YAG was associated with greater improvement than PDL, particularly in lesion color, although larger randomized studies are needed to confirm these findings.