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Treatment of Port-Wine Stains With New Laser Techniques
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Am Fam Physician. 1999 Nov 15;60(8):2420.
Port-wine stains are a congenital, progressive ectasia of the superficial cutaneous vascular plexus. Over time, these superficial vessels can become ectatic and produce a darkening and thickening of facial port-wine stains. Treatments, which have included excision, dermabrasion, cryotherapy, sclerotherapy, irradiation and placement of radioactive implants, often resulted in pain and scarring. New laser techniques such as the flashlamp–pumped pulsed tunable dye laser (FLPDL) permit the use of longer wavelengths and pulse widths to encourage heating of hemoglobin and result in more effective thermal coagulation. The intense pulsed-laser functions are based on principles of selective photothermolysis that allow treatment of larger and more selective vessels. These methods are effective in heating the upper as well as the deeper vessels of port-wine stains and result in gentle, uniform heating of the vessels and fewer cosmetically unacceptable results. Raulin and associates evaluated the use of intense pulsed light source (IPLS) in the treatment of port-wine stains.
A total of 37 patients with 40 port-wine stains were treated over a three-year period. Because of the retrospective nature of the study, no uniform treatment parameters were used. Three nonparticipating physicians reviewed pretreatment and post-treatment photographs of the lesions to evaluate lightening of the port-wine stains. The degree of clearance was determined as a percentage of reduction in color relative to normal skin. Results were ranked into one of four categories: 100 percent clearance, 70 to 99 percent clearance, 40 to 69 percent clearance and less than 40 percent clearance.
Clearance of 70 to 99 percent of pink port-wine stains occurred with an average of 2.8 treatment sessions, red stains with an average of 1.4 treatment sessions, and purple stains with an average of 4.2 treatment sessions. In five of 14 pink port-wine stains, 100 percent clearance was observed after four treatment sessions. Two of 15 red port-wine stains completely cleared after 1.5 treatment sessions. In purple port-wine stains, 100 percent clearance did not occur. In 77.7 percent of the total treatment sessions, a single pulse was applied. Double pulses and triple pulses were also used but less frequently.
Treatment results for previously untreated port-wine stains (n = 28) included seven with complete clearance, 14 with good clearance and six with only fair clearance. Previously treated port-wine stains (n = 12) showed 100 percent clearance in one case of red port-wine stain. Good clearance was observed in two red and four purple port-wine stains, while one red and three purple stains showed only fair results. One red port-wine stain showed poor clearance. Therefore, results indicated complete and good clearances in 75 percent of the previously untreated port-wine stains in contrast to 58.3 percent of the previously treated port-wine stains.
Side effects included immediate erythema in all treatment sessions and immediate purpura (in 76 percent of treatment sessions) that persisted for a maximum of seven days but typically lasted 24 to 72 hours. Swelling that lasted for several hours was common. Blisters were rarely observed. Crusting that resolved within one to two weeks was noted in 20 percent of the treatment sessions. Hypopigmentation and hyperpigmentation were rare events and, if present, resolved within two to four months. No scarring or textural changes resulted.
The authors conclude that IPLS is a useful alternative, adjunctive or primary treatment of port-wine stains. Combined with a low incidence of side effects and success in treating FLPDL-resistant dark types of port-wine stains, the reduction of vessel rupture and its associated purpura and hyperpigmentation are significant benefits of the IPLS method.
Raulin C, et al. Treatment of port-wine stains with a non-coherent pulsed light source. A retrospective study. Arch Dermatol. June 1999;135:679–83.
Copyright © 1999 by the American Academy of Family Physicians.
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