Treatment of angiokeratoma of Mibelli is usually challenging because of the location, the pathogenetic condition and the cosmetic requirements. We present our characteristic treatment with the application of pulsed dye laser PDL and lpNd:YAG laser. All of these lesions were treated by topical anesthesia with Emla. Combined dual PDL-lpNd:YAG (PDL: 595 nm, 5 mm/7 mm, 0.5 ms, 8-10 J/cm(2) ; lpNd:YAG: 3 mm/5 mm, 15 ms, 90-120 J/cm(2) ) treatment was used to treat lesions which with moderate to severe hyperkeratosis and hyperplasia. To the maculopapule ones, the energy density of lpNd:YAG might upgrade to 150 J/cm(2) . Singular PDL (595 nm, 5 mm/7 mm, 0.5 ms, 9-12 J/cm(2) ) treatment was used to treat lesions which with slight hyperkeratosis and hyperplasia. Continuous airflow cooling was always applied during the laser treatment. The treatment interval was 6-12 weeks. Of the 5 patients, 3 of them were cured and 2 of them were improved. All of them were satisfied with the cosmetic results. We recommended the combined dual PDL-lpNd:YAG laser in treating severe hyperkeratotic and hyperplastic angiokeratoma of Mibelli. It can aid in achieving a desirable outcome whilst also reducing the required treatment sessions. However, most patients felt painful during the operation and experienced a severe long term recovery time after operation.
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