FIGURE 1.
After Bleomycin ElectroScleroTherapy (BEST) flagellate dermatitis can occur on the sites of skin. (A) Scratching can cause permanent hyperpigmentation due to bleomycin. (B) Marks of the electrode insertion are visible at the site of the treatment.
TABLE 1.
Recommended preparation and dosing of intralesional injection (neat or foamed) of bleomycin for Bleomycin ElectroScleroTherapy (BEST)
| Concentration | Preparation for injection | Maximal dose per session | Cumulative dose in all sessions | |
|---|---|---|---|---|
| Bleomycin and contrast | 1 000 IU/ml in NaCl solution | 1 part of solution in 3 parts of Contrast Medium (250 IU/ml) | 10 000 IU in adults | 100 000 IU in adults |
| 200 IU/kg in children | 1 300 IU/kg in children-divided by number of sessions | |||
| Divide the total dose into anticipated number of sessions | ||||
| The interval between sessions should be at least 8 weeks | ||||
| Foamed bleomycin | 1 000 IU/ml in NaCl solution | 1 ml albumin; 1 ml plain 1% lidocaine; 8 000 IU bleomycin; contrast agent may be added; orthogonal 3 way tap connection; 5 ml air- or according to local practice | As above | As above |
FIGURE 2.
Procedure of Bleomycin ElectroScleroTherapy (BEST) in the treatment of low-flow vascular malformation on the lip. (A) Patient pre-treatment. (B) After the injection of bleomycin solution, the (C) electric pulses were applied on several areas with the finger electrode, avoiding overlap of the electric field. Procedure was completed in 10 minutes. The treated malformation was compressed (D) for several minutes to stop bleeding. Due to the vascular effects of BEST, the bleeding stopped spontaneously.
FIGURE 3.
Example of Bleomycin ElectroScleroTherapy (BEST) treatment effectiveness on low-flow vascular malformation. After treatment, the treated area is oedematous, with a scab over the treated area after 3 weeks. The scab falls off in about 6 weeks with already visible treatment effectiveness. After 3 months, an excellent effect is visible after one treatment only.
FIGURE 4.
Microcystic lymphatic malformation before Bleomycin ElectroScleroTherapy (BEST) (A) and one year after (B). A significant reduction of the malformation is observed.