Treatment of resistant port wine stains with the V Beam pulsed dye laser

Pulsed dye lasers (PDL; 585 nm, 0.45 millisecond) are the treatment of choice for port wine stains (PWS). However, clearance rates vary widely and are in many patients incomplete. The objective of this prospective pilot study was to investigate the effects of a long pulse-duration 595 nm PDL (V Beam, Candela Laser Corporation, Wayland, MA) on previously treated PWS to ascertain whether further lightening can be obtained. Treatment response was assessed subjectively (photographs) and objectively with noninvasive techniques (reflectance spectrophotometer and spectrophotometric intracutaneous analysis scope (SIAscope)).

Twelve adult patients with congenital PWS each had four test patches with different spot sizes, fluences, and pulse widths carried out. The test area with the best response was selected and two laser treatments were performed at weeks 8 and 16. Photographs and measurements with a reflectance spectrophotometer and SIAscope (Astron Clinica, Cambridge, UK) were performed at baseline, before each treatment and at final review at week 24.

Of the nine patients who completed the study three patients showed a good response (51-75% lightening), which was supported by measurements with the reflectance spectrophotometer and the SIAscope. A further three patients had fair improvement (26-50% lightening) and three patients had a minor or no response (0-25% lightening). In two patients a discrepancy between the degree of clinical response and some of the objective measurements was noticed.

The 595 nm V Beam PDL appears to achieve further lightening of therapy-resistant PWS in the majority of patients (67%). Both reflectance spectrophotometer and SIAscope appear to permit assessment of objective treatment responses. Results require confirmation in larger studies.