Prospective pilot study on combined use of pulsed dye laser and 1% topical rapamycin for treatment of nonfacial cutaneous capillary malformation

Background: The regeneration or revascularization of blood vessels after pulsed dye laser (PDL) treatment is one of the causes of treatment failures of cutaneous capillary malformations (CM). Recently, topical administration of rapamycin was introduced as a possible adjunctive therapeutic option to minimize postlaser revascularization in facial CM.Objectives: We evaluated the effect of combined use of 1% topical rapamycin with PDL compared to PDL alone in cutaneous CM of trunk or extremities and tried to identify the optimal duration of topical rapamycin application.Methods: Three adjacent areas of cutaneous CM that had never been treated before were selected in each patient and underwent the following regimens: (A) PDL+vehicle for 8weeks post-PDL; (B) PDL+topical rapamycin for 1-week post-PDL and (C) PDL+topical rapamycin for 8weeks post-PDL. Each test site was treated by PDL for two sessions with 8weeks interval.Results: Only one of six patients showed clinical improvement with combined rapamycin treatment. Overall, there was no statistically significant difference in erythema and blanching rate among PDL alone and combined rapamycin regimens.Conclusion: One percent topical rapamycin does not seem to be effective as a treatment modality for cutaneous CM of trunk or extremities.