Capillary abnormalities of the head and neck area may result in psychological and physical distress. Patients frequently seek alternative treatment techniques since the efficacy of current laser and light therapy is still poor. Cosmetic concealment, surgery, and medical tattooing are further acknowledged but seldom recommended treatments. The goal of this systematic review was to assess the efficacy and safety of known treatments for untreated capillary malformations of the head and neck, including laser and light treatment methods, photodynamic therapy, cosmetic concealment, medical tattooing, and surgery. The Grading of Recommendations Assessment, Development, and Evaluation method was used to grade predefined treatment and safety outcomes using pooled data (GRADE). The study included 48 observational studies and three randomised controlled trials that evaluated nine different treatments. There was no research that satisfied the inclusion criteria on surgery or cosmetic concealment. After three to eight treatment sessions, the pooled proportion of patients achieving a 75 per cent clearance was 43 per cent with the pulsed dye laser. Other treatments were ineffective. Following the pulsed dye laser, hyperpigmentation was most commonly noted. The pain was most prevalent during photodynamic treatment, although the severity was not recorded.
The pulsed dye laser appears to be better for treatment-naive capillary malformations in the head and neck area, but it causes more hyperpigmentation than other treatments. For research comparability, future studies should use uniform outcome measures and established metrics. Based on the findings of this comprehensive review, physicians and patients should be aware of the inadequate evidence about current treatment choices when making treatment decisions for capillary malformations.
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