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Comparison of the efficacy and safety between a low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser and a conventional Q-switched 532-nm laser for the treatment of cafe-au-lait macules in 40 Chinese children: a prospective, randomized, parallel-controlled, evaluator-blinded trial

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Abstract

Cafe-au-lait macules (CALMs) affect the appearance of patients and can result in serious psychological problems. Successful treatments without adverse effects remain challenging. We designed a prospective, randomized, controlled, evaluator-blinded trial on 40 pediatric patients to compare the efficacy between a low-fluence 1064-nm Q-switched Nd:YAG laser and a Q-switched Nd:YAG 532-nm laser for the treatment of solitary CALMs in children. We randomly assigned participants into 2 groups. We treated those in the first group with 3 sessions of 532-nm QS laser at 1-month intervals, and those in the second group with 6 sessions of 1064-nm LFQS laser at 2-week intervals. We found no significant differences in treatment efficacy (p = 0.14). The 1064-nm laser group referred significantly less pain than the 532-nm laser group (p = 0.0001). Side effects were detected in 5 patients in the 532-nm laser group. The difference of the side effects was statistically significant (p = 0.04). Two patients in 532-nm laser group were recurred and none in 1064-nm laser group. On a univariate logistic regression analysis, lesions with brown color, small size, and irregular edges were significantly associated with better outcomes (> 50% clearance). Multivariate logistic regression analysis found that brown lesions and lesions with irregular edges had higher odds of getting > 50% clearance (p < 0.05). In conclusion, the 1064-nm LFQS laser produced fewer side effects, less pain, and shorter recovery time than the 532-nm laser. Irregular-bordered, smaller, brown lesions improved better than smooth-bordered, larger, light brown lesions. Moreover, the 1064-nm laser may be a better choice for treating large size CALMs. However, no significant differences were found in terms of the treatment efficacy and recurrence.

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Acknowledgments

We thank the patients and their families for their ongoing participation in this study. Their understanding was important in ensuring the success of this important clinic trial.

Funding

This publication presents independent research funded by the most important clinical discipline in Shanghai (2017ZZ2026-02), National Nature Science Foundation of China (81630083). There was no commercial support for this study.

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Author notes

  1. Yin Zhuang and Minghuan Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Yin Zhuang, Jinwen Shen, Lei Wang, Liping Yang, Aifang Jiang, Zhirong Yao & Xia Yu

  2. Institute of Dermatology, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China

    Yin Zhuang, Jinwen Shen, Lei Wang, Liping Yang, Aifang Jiang, Zhirong Yao & Xia Yu

  3. Department of Dermatology, Dongfang Hospital, Tongji University, Shanghai, China

    Minghuan Huang

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  1. Yin Zhuang
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  4. Lei Wang
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Corresponding author

Correspondence to Xia Yu.

Ethics declarations

The study was carried out in accordance with the Declaration of Helsinki, approved by Xinhua Hospital Ethics Committee Affiliated to Shanghai Jiaotong University School of Medicine (XHEC-D-2019-108). All patients signed informed consent before participating in the study.

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The authors declare that they have no conflict of interest.

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Zhuang, Y., Huang, M., Shen, J. et al. Comparison of the efficacy and safety between a low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser and a conventional Q-switched 532-nm laser for the treatment of cafe-au-lait macules in 40 Chinese children: a prospective, randomized, parallel-controlled, evaluator-blinded trial. Lasers Med Sci 37, 279–286 (2022). https://doi.org/10.1007/s10103-021-03245-w

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