What is laser treatment?
Laser treatment uses energy from light to make some skin problems less noticeable, or in some cases, get rid of the skin problem completely.
What types of skin problems can be treated with laser?
There are different types of lasers. This resource will focus on laser treatments for red skin marks. Examples of the red marks that laser can help improve are:
- port wine stains
- leftover redness from hemangiomas
- noticeable blood vessels
How good is laser at treating skin problems?
It depends on the skin problem. For example, many children with port wine stains get some improvement, but some get no improvement. It is not very common to completely get rid of port wine stains. For other skin problems, your child’s health-care provider can give you more details about the chance of improvement.
How can I find out if laser can help my child's skin condition?
If laser treatment might help your child, they will be referred to a laser clinic for a consultation. During that consultation, the doctor will assess your child and the skin problem and let you know if laser is likely to help. If laser may help, they will explain the laser procedure to you and answer your questions.
How many laser treatments will my child need?
Different skin problems need different numbers of treatments. It might only take one or a few sessions to improve your child’s skin problem, or it may take many sessions. You may be given an approximate number during the consultation. Most port wine stains need many treatments.
How often will laser treatments need to be done?
Treatments are usually done once every one to three months. After the estimated number of treatments are completed, your child may be offered a few more treatments if they are likely to benefit from them. If your child is receiving treatments in a paediatric centre, their health-care team may start transitioning them to an adult treatment centre when they turn 16 or 17 if more treatments are still needed.
What is the best age to have laser treatment done?
Families often want to start treating as early as possible to try to get a better outcome. There are not enough studies yet to know the best timing. Many children treated when they are older still get good results.
Does laser treatment cost money?
Some laser treatments for certain conditions may be covered by provincial health plans. Your health-care provider will let you know if the skin condition in question is covered and if not, what the anticipated fees will be.
Possible risks of laser treatment
Risks can include anxiety and pain, which can be helped with medication and/or waiting until your child is older.
Dyspigmentation—skin that is lighter or darker than your child’s normal skin colour—can happen at the laser treatment site. The spots are often circles in the shape of the laser. Children with darker skin colour may be more prone to this. This risk can be addressed by the health-care team by choosing different laser settings. Children with tanned skin are also more at risk of dyspigmentation, and this too can be addressed with different laser settings or waiting for the tan to fade before treating again.
Burns, blisters, wounds, infections and permanent scars are rare risks but can occur.
Possible risks of sedation
Risks of intravenous sedation in otherwise healthy children are uncommon but will be discussed by the anaesthesia team prior to sedation.
Does laser hurt and what can we do about this?
Some people find each laser “pulse” stings, and other patients do not find the sensation painful. Numbing cream (topical anaesthetic) can be used before the treatment to help with discomfort. If your child would like to have numbing cream, this will be put on by a member of the health-care team at the treatment centre or laser clinic once the treatment area(s) have been chosen.
What if my child is nervous about the treatments?
It is common to be nervous about treatments. This is especially common with younger children. The following are some of the reasons for nervousness:
- Laser treatment is a new experience.
- Your child will need to wear goggles that block their vision in order to protect their eyes from damage.
- Some children worry about pain.
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
If your child is still nervous, there are many strategies that can help, including listening to music or having a favourite toy for example. Some children would benefit from a small dose of an anti-anxiety medicine before the intravenous is put in.
Children under the age of 6 are often more nervous about laser treatments. The laser treatment centre may be able to treat children under the age of 6 with sedation (often with intravenous medicines) as they often do not tolerate laser treatments without sedation.
Giving consent before the procedure
Before the procedure, the health-care team will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks and will help you weigh any benefits against the risks. It is important that you understand all of these potential risks and potential benefits of the laser treatment and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
Before the appointment
- Your child will not be permitted to eat or drink for several hours before the appointment. Your health-care team will give you instructions for this.
Day of appointment
***If your child has a fever or is unwell, do not bring them for the appointment, and let the team know.
Timing
- Allow for about five hours in the day treatment centre.
- You will be instructed on what time to arrive. Your arrival time will be well in advance of the actual treatment. This allows for the sedation team and the dermatology team to all do their assessments and preparations.
- If you arrive late, your appointment may need to be rescheduled.
Who can be with your child?
- Both parents or caregivers may be with your child before and after the treatment but are not allowed in the treatment room.
- DO NOT bring siblings who will need supervision.
What to bring?
- There can be long periods of waiting, so bring activities such as small toys, books, music and/or a tablet.
- Do NOT bring snacks, meals or drinks for the time BEFORE the treatment.
Arriving for treatment
- Once you have arrived, different members of the health-care team will check your child and talk to the family. The team includes:
- the nurses from the day treatment team
- the sedation team staff
- the dermatology nurses and doctors
- If your child has a viral illness but no fever, the sedation team will assess and determine if it is safe to sedate your child. If sedation cannot happen with your child’s illness, the appointment will need to be re-scheduled. This can be disappointing when the family has prepared and made arrangements to be in the hospital for the morning. Young children often get viral illnesses, and all decisions are made with the utmost safety of the child in mind.
Medications before treatments
- If your child gets cold sores, they may need medicine to stop cold sores from developing in the treated area.
- Your child will be offered numbing cream. This will be put on by the dermatology nurse once the treatment area(s) have been chosen.
Photographs
Photos will usually be taken at each visit. This helps the health-care team monitor the results of laser treatment.
First laser treatment
Your child’s first laser treatment is usually a test treatment ONLY and is done on small areas.
Laser treatments
Your child will start in a pre-treatment room where they will be until the laser treatment, and they will come back to this room after the treatment. You can be with your child in the pre-treatment room before the procedure. You can wait there until the treatment is over and your child is brought back. When your child is brought to the laser room, you can go with them while the anaesthesia team begins to put the intravenous in. At that point, you will be asked to go back and wait in the pre-treatment area. Expect your child to be in the treatment room for about 15 to 30 minutes.
After each treatment
- Petroleum jelly will usually be put on the treated area. Sometimes a cold pack and/or a cortisone cream may be used if there is swelling.
- If your child feels dizzy or unwell, let the clinic staff know. Some children need to rest longer after treatments before they go home.
Does laser have side effects or complications?
There can be some temporary side effects that go away in a few days to a few weeks. For example, bruising is common. Occasionally, the skin’s regular colour will get lighter or darker than usual at the site of the laser treatment. This usually goes away but can take time. Using very good sun protection can help to minimize this risk. Sunscreen that is broad-spectrum with a minimum sun protection factor (SPF) of 30 is recommended. If the treatment area is on the body, it is ideal to wear clothing that covers the area.
Side effects such as burns, wounds, blisters, infections or scars are very rare but can happen.
After care
- Although it is uncommon, your child may have pain after laser treatment. If there is pain, acetaminophen may be used. Avoid ibuprofen and naproxen.
- If there is swelling, your child may use a cool pack. Do not place the cool pack directly against the skin.
- Apply petroleum jelly (or equivalent) to the treatment site for a few days after treatment.
- If a cortisone cream is prescribed, follow the instructions on the package or from the health-care provider.
- Daily sun protection is required. This includes hats, protective clothing and sunscreen. Children with tanned skin have a greater risk of having dyspigmentation (lighter or darker areas) in the treated areas. Good sun protection should be used in the month leading up to treatment and the month after treatment.
Alert the laser clinic if:
- There are blisters, open wounds, “scabs” or lighter or darker skin in the treated areas. A member of the treatment centre team may ask you to take photos so that they can better assess the area.
- A “scab” forms. Do not pick at any scabs. Cover them with petroleum jelly and a bandage if needed.
Seek prompt medical attention if:
- You see increasing redness around an area that was treated.
- Your child has increasing pain in a treated area.
- There is a wound with pus.
At SickKids — Dermatology Laser Treatment Program
If we are offered laser treatments, what are the next steps?
- If you are not interested in having your child start laser treatments or do not think your child is ready or wish to wait until your child is older, they will be discharged back to their primary health-care provider. Your child can be referred back when and if you/they are ready to consider laser again.
- If you wish to proceed, a decision will be made about whether your child needs sedation (this will happen in a specialized treatment unit) or not (treatment will be in the regular laser clinic). The wait lists for these are different. Sedation is usually offered for children under 6 years old; many children 6 years old and older can try laser without sedation.
- If an application needs to be made to OHIP to cover the cost of treatments, this will be sent by the Dermatology Clinic. A response can take about three months. Note that OHIP does not always approve coverage of laser treatment.
- Your child will now be placed on a waiting list, and you will be informed as soon as there is an opening to start treatments.
The laser treatments waiting list
SickKids often has more patients who want treatment than available spaces in the laser treatment program. The SickKids Dermatology Laser Treatment Program keeps a waiting list and offers families an opening as soon as it is available. The waiting list can be long, especially for patients under 6 who would need treatments with sedation. Sometimes, the waiting list is closed because it is full. There are a few other treatment centres that might have shorter lists. Please speak with your health-care provider if you would like to be referred to an alternate centre.