Laser therapy effective in blanching port-wine stain birthmarks

Pulsed-dye laser therapy is effective in blanching most port-wine stain birthmarks, according to a report in the September/October Archives of Facial and Plastic Surgery.

“The current standard of care treatment, the pulsed-dye laser in combination with epidermal cooling, can achieve port wine stain (PWS) blanching safely in many patients,” Dr. Kristen M. Kelly from the Beckman Laser Institute, University of California, Irvine, told Reuters Health. “However, multiple treatment sessions are required (in many cases 10 to 15 or more), complete blanching does not occur in the majority of cases, and there are resistant lesions that respond minimally even after many treatments.”Dr. Kelly and colleagues reviewed the current status of treatments for PWS birthmarks. In the authors’ experience, pulsed-dye laser in combination with epidermal cooling (to reduce the risk of epidermal injury and scarring) results in 75% or greater blanching in 20% of subjects average an average of 3.3 treatments. Some 30% of patients show a minimal response, however, even after multiple treatments.Pulsed-dye laser treatments are repeated at 8- to 12-week intervals, the report indicates, and each treatment results in local swelling, ecchymoses, and postoperative pain similar to that of a sunburn.Recent advances in laser and epidermal cooling technology have not resulted in improved outcomes, the investigators note, although long-term adverse effects, including scarring or permanent dyspigmentation, did not occur.Forty percent of patients treated with the newer approach, however, had shown limited treatment responses to pulsed-dye laser, the researchers explain.Current research aims to determine noninvasively the depth and size of PWS blood vessels in an effort to improve selection of laser settings and optimize lesion blanching with current technology.”Alternative or adjunct treatments should be explored, including noninvasive real-time imaging to optimize selection of treatment settings, photodynamic therapy, and perioperative use of antiangiogenic factors,” the investigators conclude.”We have designed a treatment protocol whereby we initiate treatment with subtherapeutic photodynamic therapy exposure, causing initial vascular damage, and presumably leaving PWS blood vessels more vulnerable to subsequent photothermal damage,” the authors explain. “The pulsed-dye laser irradiation is then used to selectively heat the pretreated vessels compromised by photodynamic therapy.”(Source: Arch Facial Plast Surg 2005;7:287-294: Reuters Health: Oncolink: September 2005.)