Laser treatment of congenital facial port-wine stains: long-term efficacy and complication in Chinese patients

BACKGROUND AND OBJECTIVE: Pulsed dye laser (585 nm, 450 micros) and variable pulse width frequency doubled Nd:YAG 532 nm laser have been proven to be effective in treating vascular lesions in Caucasians especially in facial port-wine stain. Their roles in dark-skinned Asian have not been determined. The objective of this study was to assess the long-term outcome and complication of laser treatment of congenital facial port-wine stain in Chinese patients retrospectively. Study Design/Materials and Methods: Files of all patients with port-wine stains who had received laser treatment in a major regional laser center in a 5-year period were reviewed. Chinese patients with congenital facial port-wine stains were recruited for the study. They were called back for questionnaire assessment of their degree of clearance and clinical examination for treatment complication. Detail demographics, result of questionnaire and clinical examination were entered into a database and statistical analyses were conducted where applicable. RESULTS: One hundred and seven patients with congenital facial port-wine stain were recruited for the study. Thirty-six patients had received PDL treatment, 40 patients had VP532 treatment and 31 patients had been treated by both laser systems. A total of 665 treatment sessions had been performed with an average of 6.1 +/- 2.8 sessions (range 3-12). They had been followed-up from 2 to 5 years with a mean period of 3.4 +/- 1.1 years. Over 60% of patients had more than 25% of clearing and the majority of patients (41.1%) had 25-50% of clearing. Less than one-quarter of patients (23%) experienced a clearing more than 50% and no patient had complete clearing. There was no significant difference in the subjective assessment of clearing between patients that had different forms of laser treatments. No patient had recurrence of pigmentation after treatment. Fourteen percent of patients experienced complications and the majority of them had pigmentary changes. Sex, age, number of treatment session, and type of laser machine used were not related to a higher complication rate using the multiple regression analysis. CONCLUSIONS: Chinese patients were less responsive to laser treatment with higher complication rate. In addition, more treatment sessions were required to achieve a maximum clearing. However, most of our patients were satisfied with laser treatment (Patient Satisfaction Score=7.25). Dark-skinned patients should not be excluded from laser therapy provided that treatment expectations and risks are fully discussed.     

Dye laser treatment of port-wine stains

The author treated 456 cases of port-wine stains using a tunable dye laser (577-nm wavelength, 1-microsecond pulse, 2-3-mm diameter spot), and followed up 22 cases for a year or more after the initial treatment. The treatment was regarded as effective in 80.5% of the abnormal lesions. The results were influenced by location: good results were achieved in the neck region and face, but results in the extremities were poor. The dye laser can achieve selective injury to abnormal vessels of port-wine stains while inflicting less damage to the overlying dermis than the argon laser. Therefore, dye laser treatment for port-wine stains is more effective than argon laser treatment.     

Treatment of Port Wine Stains with Intense Pulsed Light: A Prospective Study

BACKGROUND: Recent studies have shown that intense pulsed light can be useful in treating port wine stains that were resistant to previous pulsed dye laser therapy. Asian persons with high epidermal melanin context can be at a higher risk of complication. OBJECTIVE: The aim of this study was to conduct a prospective trial to assess the efficacy and complication of intense pulsed light in the treatment of port wine stains in Chinese patients. METHODS: Twenty-two Chinese patients with port wine stains without previous treatment were recruited to receive intense pulsed light source therapy for five to seven treatments at intervals of 3 to 4 weeks. Patient demographics, skin type, characteristics of port wine stains including color and location, treatment parameters, degree of pain caused by intense pulsed light treatment, percentage of clearing, and treatment complications were recorded and entered into a database. A questionnaire was conducted to assess the influence of treatment on daily activity and the intensity of pain experienced during treatment. RESULTS: There were 17 female and 5 male patients. Their ages ranged from 6 to 45 years with a mean age of 21.8+/-10.1 years. More than 90% of patients had more than 25% of clearing and the majority of patients (50%) had 25% to 50% of clearing. Although 40% of the patients showed more than 50% clinical clearance, 9% of the patients were able to achieve more than 75% clearing. The only 2 patients with less than 25% clearing had nodular port wine stains and no patient was able to achieve complete clearing. The procedures were well tolerated with a mean pain score of 2.1+/-0.9 and the treatment had no influence on daily activity. One patient developed blisters and 6 patients had swelling for more than 24 hr that all resolved within 1 week without leaving permanent marks. They have been followed up from 12 to 27 months and there was no long-term complication. CONCLUSION: Intense pulsed light can be effective in treating port wine stains in Asian patients. In experienced hands, complications can be low and should be considered as one of the therapeutic options.     

Does interval time between pulsed dye laser treatments for port-wine stains influence outcome? A systematic review and meta-analysis

Lasers in Medical Science - The pulsed dye laser (PDL) is the standard treatment for port-wine stains (PWS). Maximal improvement occurs after multiple treatment sessions; however, the optimal...     

The Multilayer Technique: A New and Fast Approach for Flashlamp-Pumped Pulsed (FLPP) Dye Laser Treatment of Port-Wine Stains (Preliminary Reports)

BACKGROUND: The 585 nm flashlamp-pumped pulsed (FLPP) dye laser is an effective and established treatment for port-wine stains (PWSs) during childhood. Unfortunately, PWSs tend to darken in color and may thicken or develop nodules as the lesions age, thereby making treatment difficult in adult patients since they may require several laser sessions producing unpredictable results. The aim of this article is to present and discuss the results obtained in four adult patients with PWS by use of a new approach in FLPP dye laser treatment. OBJECTIVE: The goal of this technique was to damage, during the same treatment, the lesions at both deep and superficial levels and to reduce the number of laser sessions required to obtain the most effective eradication of hypertrophied PWSs. METHODS: Four patients (two men and two women aged 54, 57, 49, and 61, respectively) were referred for treatment of congenital hypertrophied PWS of the face. Every dye laser session consisted of two laser passes. During the first pass the wavelength ranged from 590 to 600 nm with a long pulse (1.500 microseconds), while the second pass was performed utilizing the classic short pulse (450 microseconds) and wavelength (585 nm). Successive treatments were performed at 6- to 8-week intervals. RESULTS: All four patients had a complete clearing of their PWS after a number of treatments, ranging from three to five sessions. Three of them (one man and the two women) experienced extremely mild blistering in a limited small area that healed in approximately 10 days without scarring. The laser sessions were well tolerated by all patients. None of the patients developed atrophic or hypertrophied scars or dyschromia. CONCLUSIONS: Our results show an excellent response in all patients with just a few treatments (three to five sessions) and, in spite of two passes, only mild side effects that are probably limited due to cooling of the skin. We also observed a flattening and reduction of the nodules.     

Dye laser treatment of port-wine stains

The author treated 456 cases of port-wine stains using a tunable dye laser (577-nm wavelength, 1-s pulse, 2–3-mm diameter spot), and followed up 22 cases for a year or more after the initial treatment. The treatment was regarded as effective in 80.5% of the abnormal lesions. The results were anfluenced by location; good results were achieved in the neck region and face, but results in the extremities were poor. The dye laser can achieve selective injury to abnormal vessels of port-wine stains while inflicting less damage to the overlying dermis than the argon laser. Therefore, dye laser treatment for port-wine stains is more effective than argon laser treatment.     

Intense Pulsed Light for the Treatment of Refractory Melasma in Asian Persons

BACKGROUND: Patients with dermal or mixed-type melasmas are often refractory to various treatments. Intense pulsed light has been used to treat melanocytic lesions with promising results. OBJECTIVE: The purpose of this study was to clarify the effectiveness of intense pulsed light for refractory melasma in Asian persons. METHODS: Seventeen patients were treated with intense pulsed light, during four sessions at 4-week intervals. The patients were also given 4% hydroquinone cream and broad-spectrum sunscreens to prevent and treat postinflammatory hyperpigmentation. Sixteen patients in the control group were treated with hydroquinone cream and sunscreens. The treatment efficacy was evaluated using reflectance spectrophotometer and patient satisfaction questionnaire. RESULTS: Patients in the intense pulsed light group achieved an average of 39.8% improvement in relative melanin index, compared to 11.6% improvement in the control group (p<0.05) at Week 16. Six (35%) patients in the intense pulsed light group had more than 50% improvement, compared to two (14%) patients in the control group. Two patients in the intense pulsed light group, however, experienced transient postinflammatory hyperpigmentation, and partial repigmentation was noted 24 weeks after the last treatment session. CONCLUSION: Intense pulsed light is a safe and effective treatment for refractory melasma in Asian persons, with minimal side effects. Further treatment sessions are required for maintenance therapy.     

Use of a lignocaine-prilocaine cream as an analgesic in dye laser treatment of port-wine stains

A eutectic mixture of two local anaesthetics—prilocaine and lignocaine (EMLA cream)—has been investigated for its usefulness as an analgesic in the treatment of facial port-wine stains with the tunable dye laser. The cream provided adequate analgesia in eight of 10 patients assessed and was well tolerated. The results of treatment after use of EMLA cream were no different from those where conventional analgesia had been used, and EMLA cream can be recommended for analgesia during laser treatment of port-wine stains.     

倍频Nd:YAG532nm波长激光治疗鲜红斑痣疗效观察

目的 :观察倍频Nd :YAG5 32nm波长激光治疗鲜红斑痣效果。方法 :1997年 3月至 1999年 10月 ,选择其可变脉宽 5 32nm波长激光治疗鲜红斑痣 387例 ,治疗过程中同时使用冷却头冷却皮肤 ,每次治疗间隔 2～ 3个月。结果 :平均治疗 5 .6次 ,总有效率 95 %。 15例出现暂时性色素沉着 ,3例皮肤出现点状萎缩性瘢痕 ,6个月后均消退 ,2例出现增生性瘢痕。结论 :可变脉宽 5 32nm波长激光治疗鲜红斑痣效果良好 ,并发症少 ,是目前较理想的治疗方法     

Hereditary Port-wine Stains, Do They Exist?

. Patients with a port-wine stain applying for laser treatment often mentioned having a member in the family with a similar birthmark. Of 280 consecutive new patients with a port-wine stain 55 mentioned relatives with the same anomaly. Family tendency (19.6%) for vascular malformations in our group was significantly higher than mentioned by others. Pedigrees were made of 32 families with two or more affected members, including probands. We present nine representative pedigrees of families with three or more members affected by port-wine stains. In these families no clear mode of inheritance can be discerned. Genetic linkage studies identified causative gene defects in certain venous malformations and Rendu–Osler–Weber disease. Knowledge of new theories on angiogenesis and molecular genetics has to be linked to our patients with familial port-wine stains. Paper received 12 February 1999; accepted following revision 1 March 1999.     

Assessing argon laser therapy of port-wine stains

The outcome of argon laser therapy of port-wine stains (PWS), treated over an 8-year period, has been investigated. Of 571 patients that have attended a clinic between 1984 and 1992, a definite outcome of treatment has been derived for 417 patients. Outcome was assessed clinically in terms of lightening of colour and quality of skin surface after therapy. Transcutaneous microscopy (TCM) was also used to provide an initial classification of the nature of the PWS abnormality and to assist in the assessment of the outcome. Good to excellent results were achieved in 44% of the older patients, aged above 18 years. This result was achieved in 23% of children, aged 18 years and below. The outcome of treatment may related to the classification of the lesion. The majority of the lesions in children were classified as the types containing relatively normal blood vessels, whereas many of the older patients had lesion types containing dilated ectatic vessels.     

强脉冲光治疗微静脉畸形的临床观察

目的：探讨强脉冲光（IPL）治疗微静脉畸形的治疗效果。方法：回顾性分析2007年7月～2012年6月在本院整形美容外科用强脉冲光治疗粉红型、紫红型及增厚型微静脉畸形患者104例。结果：104例粉红型、紫红型及增厚型患者经IPL治疗后总有效率分别达78．9％、72．4％和94．4％,但是对不同类型间的微静脉畸形疗效无统计学意义（P〉0．05）,治疗后出现水疱5例（4．8％）,色素沉着7例（6．7％）,增生性瘢痕3例（2．9％）,治疗区域色素不均匀5例（4．8％）。结论：IPL治疗粉红型、紫红型及增厚型微静脉畸形疗效可靠、并发症少、是治疗微静脉畸形的有效方法。     

Results of argon laser treatment of port-wine stains: a method of assessment

In this review of over 100 cases of argon laser treated port-wine stains, four parameters, including lesion colour, skin texture, make-up habits and scarring, are assessed and changes allocated appropriate numbers. The sum of these numbers is used to classify results as Excellent, Good, Fair or Poor, and these were found to correlate well with the level of patient satisfaction.     

Construction of a novel port wine stain phantom and measurement of colour by digital imaging and reflectance spectrophotometry

A novel skin phantom is described that is constructed with quantifiable amounts of skin pigments, as well as a light scattering medium in the form of barium sulphate suspension. The two predominant skin pigments (melanin and haemoglobin) are varied in controlled amounts within the phantoms to simulate skin colour in different situations. The phantoms were devised in order to simulate the changes in skin colour particularly after laser treatment of port wine stains, where superficial cutaneous vascularity is reduced. Preliminary investigations of two techniques for skin colour assessment were subsequently carried out so that their suitability for measuring colour in the skin phantoms could be considered. A specifically designed device was constructed to enable repeatable digital image capture of the phantoms. Further development of this skin phantom may enable comparison of techniques for skin colour assessment.     

Argon laser treatment of port-wine stains: A report of 321 cases from China

This paper describes the treatment of port-wine stains in 321 patients, by using the argon laser. A power of 1.0–1.5 W on a spot of 1.2–2.0 mm diameter was used freehand, and with continuous exposure the lesions were ‘painted’ until blanching was achieved. In all cases test patches were done, and were assessed after three months. Fair to excellent results, in which the colour of the lesion was reduced without scar formation, were achieved in 79% of patients. A poor result was achieved in the remainder, in whom there was either scar formation or no significant reduction in colour of the birthmark. Scarring occurred in 29 patients, pigmentation in eight and skin atrophy in six. Immediate and delayed histological effects were also observed. As reported in published work, the best results were obtained in older patients with darker marks. The need for better prediction of results and improved techniques is stressed.     

Histology of port-wine stain

Summary Our present histological knowledge of the port-wine stain is limited because of the small size of biopsies taken in the past. During the last two decades, Clodius has performed subtotal excision of port-wine stains, and has covered the defects with full thickness skin grafts. The availability of large surgical specimens of dermis affected by port-wine stain prompted the present study. Specimens from 50 locations were obtained in 28 patients. The pathomechanism of the port-wine stain was found to be telangiectasia of normal capillaries, sometimes congenital abnormal increase of the number of cutaneous vessels, or both. The theory of gradual age-dependent transformation of port-wine stain is true in regard to the colour of the affected skin, but is not valid in regard to the parallel increase of the vessel lumina and RBC filling grade. One-third of the patients below the age of 30 had the wide type lesion. The extreme histological differences in the size of the abnormal vessels, and the percentage of vascular area filled with RBC's were repeatedly noted in the different regions of the face in the same patient. Furthermore, even within the same area, the histology of port-wine stain varies greatly. The value of the small biopsies presently used for the assessment of laser treatment for these lesions is questioned.Presented in part at the Meeting of Swedish Society of Plastic Surgery, Stockholm, December 1, 1988     

Variables affecting clinical response to treatment of facial port-wine stains by flash lamp-pumped pulsed dye laser: the importance of looking beyond the skin

The response of port-wine stains (PWS) to conventional laser treatment in adults is difficult to predict. To assess the influence of local or systemic hemodynamic variables on the clearance of PWS by using flash lamp-pumped pulsed (FLPP) dye laser. All consecutive patients ages 18 years or older undergoing laser treatment for a facial PWS were eligible. Laser sessions were scheduled every 8 weeks. All patients were evaluated based on a standard scale with four evaluation categories, from no or minimal improvement to total or almost total clearance. Clearance was achieved by 50.1 % (95 % confidence interval 35.6–64.7) of patients after a maximum of 15 treatment sessions. In multivariate analysis, increased age, a newly described Type III capillaroscopic pattern, and presence of lesions in dermatome V2 were all associated with a reduced clinical response to treatment. In a model restricted to demographic pattern and patient characteristics, arterial hypertension was also associated with a lower clinical response. A strong association was found between arterial hypertension and the Type III capillaroscopic pattern. Age, arterial hypertension, capillaroscopic pattern, and body location should be considered when planning laser treatment of PWS.     

Pulsed dye laser double-pass treatment of patients with resistant capillary malformations

The pulsed dye laser is an effective and established treatment for port-wine stains and has become the generally accepted standard of care. However, in many cases, complete clearance cannot be achieved as a significant proportion of lesions become resistant to treatment. Multiple passes or pulse-stacking techniques have been used to improve the extent and rate of fading, but concerns over increased adverse effects have limited this clinical approach. In this work, a double-pass technique with the pulsed dye laser has been described, which may allow for increased depth of vascular injury, greater efficacy, and an acceptable risk profile. Our aim was to determine the efficacy and the rate of side-effects for a double-pass protocol with a pulsed dye laser (PDL) to treat patients previously treated with PDL and/or other laser modalities. A retrospective chart review was conducted of 26 patients treated with a minimum of three double-pass treatments alone, or in combination, with single pass conventional PDL. Almost half of the patients (n = 12) showed either a moderate or significant improvement in fading compared to pre-treatment photographs with the double-pass technique. In a further 12 patients, there was a mild improvement. In two patients, there was no change. Sixteen patients developed mild side-effects: blisters (n = 5), dry scabs (n = 11) and transient hyperpigmentation (n = 4). This preliminary experience suggests that a double-pass technique at defined intervals between the first and second treatment with PDL can further lighten some port-wine stains, which are resistant to conventional single-pass treatments. This technique may be a useful addition to the laser treatment of PWS and deserves further scrutiny with randomized prospective studies and histological analysis to confirm the increased depth of vascular injury.     

Treatment of Resistant Port-Wine Stains with a Variable-Pulse Pulsed Dye Laser

BACKGROUND: The conventional pulsed dye laser (PDL), operating at a wavelength of 585 nm and a pulse duration of 0.45 ms, usually does not achieve complete clearance in the majority of port-wine stains (PWSs). OBJECTIVE: In this study, we demonstrate the efficacy of a variable-pulse pulsed dye laser (VPPDL) equipped with cryogen spray cooling (CSC) in the treatment of PWS that have become resistant to PDL treatment. METHODS: Forty Asian patients with Fitzpatrick skin types III to IV were enrolled in this study. All patients had previously been treated by the PDL at least eight times (mean, 12.8+/-5.9) and had reached a treatment plateau. A VPPDL with a wavelength of 595 nm and a spot size of 7 mm was used. The patients were treated with fluences between 9 and 15 J/cm(2) and pulse durations of 1.5 to 10 ms. Four treatments were administered at 8-week intervals for each lesion. Three months after the last treatment, all patients were evaluated for the degree of improvement by two independent clinicians. RESULTS: Eight patients had excellent improvement, 9 had good improvement, 11 had fair improvement, and 12 had poor improvement. No complications were observed during the course of laser treatment. Vessels larger than 30 microm were not seen in the biopsy specimens obtained after the final treatment. CONCLUSION: The VPPDL is more effective than the PDL and the VPPDL should be used for treating PDL-resistant PWSs. Nonetheless, vessels less than 30 mum in diameter are resistant to both PDL and VPPDL treatment.     

Reconstruction of the cheek after large port-wine stain lesion resection

Background  

A laser is commonly used in treatment of port-wine stain (PWS). Although observable lightening of the stains can be achieved, complete removal is rare. A significant proportion of lesions are resistant to laser treatment, including hypertrophic lesions and scars developed after improper (unsuccessful) treatments. Alternatively, resection is used to eliminate such lesions, but the reconstruction of the aesthetic appearance of the cheek after large lesion resection remains a huge challenge.