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Treatment of children with port-wine stains using the flashlamp-pulsed tunable dye laser
O T Tan1, K Sherwood, B A Gilchrest
1Laser Center, Boston University Medical Center, MA 02118.
Insights
Flashlamp-pulsed tunable dye laser treatment effectively cleared disfiguring port-wine stains in children. Younger children required fewer laser sessions, with excellent cosmetic results and minimal side effects like transient hyperpigmentation.
Area of Science:
- Dermatology
- Medical Technology
- Pediatric Care
Background:
- Port-wine stains are congenital vascular malformations causing significant cosmetic disfigurement.
- Previous treatments for port-wine stains have had limited efficacy and potential side effects.
- The flashlamp-pulsed tunable dye laser offers a targeted approach for vascular lesion treatment.
Purpose of the Study:
- To evaluate the efficacy and safety of flashlamp-pulsed tunable dye laser therapy for pediatric port-wine stains.
- To determine the optimal number of treatment sessions required for complete stain clearance.
- To assess the long-term cosmetic outcome and identify potential side effects.
Main Methods:
- Thirty-five children (3 months to 14 years) with port-wine stains received treatment with a flashlamp-pulsed tunable dye laser (577 nm wavelength, 360 microsecond pulse duration).
- Treatment efficacy was assessed by the degree of stain clearing.
- Patient age and location of the lesion were analyzed for their impact on treatment outcomes.
Main Results:
- Complete clearing of port-wine stains was achieved in all patients after an average of 6.5 treatment sessions.
- Children under seven years old required significantly fewer sessions (5.8) compared to older children (7.1).
- 94.3% of patients had excellent cosmetic results with skin texture and color matching adjacent normal skin; transient hyperpigmentation occurred in 57%, and minor scarring in 5.7%.
Conclusions:
- Flashlamp-pulsed tunable dye laser therapy is a highly effective and safe treatment for pediatric port-wine stains.
- The laser's specific wavelength and pulse duration minimize thermal damage, leading to superior cosmetic outcomes.
- Age is a significant factor influencing treatment duration, with younger children responding more favorably.
Abstract:
Thirty-five children, three months to 14 years of age, with disfiguring port-wine stains were treated with a flashlamp-pulsed tunable dye laser. All had complete clearing of the stains after an average of 6.5 laser treatments to each lesional area; skin over bony prominences required approximately half as many sessions as skin on the cheek. Children less than seven years old required fewer sessions (mean +/- SD, 5.8 +/- 1.1) than older children (7.1 +/- 1.1; P less than 0.05). Treated skin was identical in texture and color to adjacent normal skin in 33 (94.3 percent) of the children, whereas 2 (5.7 percent) had small, isolated, depressed scars in areas accidentally traumatized soon after laser treatment. The only other side effect was transient hyperpigmentation, which occurred in 20 patients (57 percent). These results can be attributed to two distinguishing characteristics of the flashlamp-pulsed tunable dye laser: an emission wavelength of 577 nm, theoretically ideal for selective absorption by the intravascular target oxyhemoglobin, and a pulse duration of 360 microseconds, which closely matches the thermal relaxation time for dermal blood vessels and hence avoids diffuse nonspecific thermal necrosis with subsequent scarring of the treated skin.