Hypertrophic scarring in argon laser treatment of port-wine stains

The argon laser (488 to 514 nm) is being used with increasing frequency in the treatment of port-wine stains (PWS). Good results are reported, but scarring is a major complication in all series. The purpose of this paper is to describe the incidence and extent of scarring in a more definitive fashion by quantitating this complication in terms of size, elevation, and color in a consecutive series of 146 patients followed for over 1 year. Scars were assigned a severity score of 1 through 5. A midstudy evaluation led to a significant change in treatment methodology. Therefore, the patient population was divided into two groups. Group I consisted of the first 73 patients and included 30 males and 43 females with an age range of 7 to 81 years (M = 35 years). Group II consisted of the next 73 consecutive patients and included 24 males and 49 females with an age range of 12 to 75 years (M = 43 years). Group II received a different treatment technique than group I. In group I the incidence of scarring was 38 percent for patients under 12 years and 21 percent for patients over 12 years. In group II the incidence was 13.7 percent with concomitant reduction in severity. Statistical analysis (M- HX2 ) compared group I children and adults, P = 0.36; children and group II adults, P = 0.08; group I adults and group II adults, P = 0.42. The most frequent and severe scarring occurred on the upper lip and central portion of the face. Individualization of energy fluency and attention to unique patient factors in healing are important in improving results.