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The Treatment of Port-wine Stains by the Pulsed Dye Laser: Analysis of Pulse Duration and Long-term Therapy

The Treatment of Port-wine Stains by the Pulsed Dye Laser: Analysis of Pulse Duration and... Abstract • A flashlamp-pumped pulsed dye laser at 577 nm was evaluated in the treatment of port-wine stains. The degree of lesional lightening was compared following laser exposure with pulse durations of 20 and 360 μs. In addition, lesional therapy using the 360-μs pulse duration was evaluated for lightening and side effects following long-term patient observation and after repeated treatments of the same site. A total of 52 patients with port-wine stain were treated; their average age was 29 years, with eight patients less than 18 years, of whom 29 had comparative test site placement for the different pulse durations. Of these 29 patients, 25 demonstrated greater lightening at the 360-μs pulse duration test site. All 52 patients proceeded to receive full treatment placement with the 360-μs pulse duration, which resulted in an overall lightening of 42% after the initial treatment and 68% after re-treatment sessions. Forty-four percent of the patients had equal to or greater than 75% lesional lightening. Pretreatment anesthesia was unnecessary and only minimum posttreatment care was required. Mild adverse effects of epidermal change, depression, or pigmentary change appeared in only four cases and was limited to less than a 2% area in each of these lesions. These side effects did not recur when the lesions were re-treated at lower energy dosages. No posttreatment sclerosis or scarring appeared, even after multiple retreatment sessions to the same area, regardless of the anatomic location, color of the lesion, or age of the patient. The ability of the pulsed dye laser to increase blood vessel thermal damage selectivity has resulted in pulse duration—dependent changes that allow for favorable lesional lightening while significantly minimizing undesired side effects. (Arch Dermatol 1988;124:889-896) References 1. Solomon H, Goldman L, Henderson B, et al: Histopathology of the laser treatment of port-wine lesions . J Invest Dermatol 1968;50:141-146. 2. Goldman L, Dreffer R, Rockwell RJ, et al: Treatment of portwine marks by an argon laser . J Dermatol Surg 1976;2:385-388.Crossref 3. Apfelberg DB, Maser MR, Lash H: Extended clinical use of the argon laser for cutaneous lesions . Arch Dermatol 1979;115:719-721.Crossref 4. Cosman B: Experience in the argon laser therapy of portwine stains . Plast Reconstr Surg 1980;65:119-129.Crossref 5. Ohmori S, Huang C-K: Recent progress in the treatment of portwine staining by argon laser . Br J Plast Surg 1981;34:249-257.Crossref 6. Arndt KA: Argon laser therapy of small cutaneous vascular lesions . Arch Dermatol 1982;118:220-224.Crossref 7. Ratz JL, Bailin PL, Levine HL: CO2 laser treatment of port-wine stains: A preliminary report . J Dermatol Surg Oncol 1982;8:1039-1044.Crossref 8. Dixon JA, Gilbertson JJ: Argon and neodymium YAG laser therapy of dark nodular portwine stains in older patients . Lasers Surg Med 1986;6:5-11.Crossref 9. Van Gemert MJC, Hulsbergen Henning JP: A model approach to laser coagulation of dermal vascular lesions . Arch Dermatol Res 1981;270:429-439.Crossref 10. Anderson RR, Parrish JA: Microvasculature can be selectively damaged using dye lasers: A basic theory and experimental evidence in human skin . Lasers Surg Med 1981;1:263-276.Crossref 11. Anderson RR, Parrish JA: Selective photothermolysis: Precise microsurgery by selective absorption of pulsed radiation . Science 1983;220:524-527.Crossref 12. Van Gemert MJC, Welch AJ, Amin AP: Is there an optimal laser treatment for portwine stains? Lasers Surg Med 1986;6:76-83.Crossref 13. Greenwald J, Rosen S, Anderson RR, et al: Comparative histological studies of the tunable dye laser and argon laser: The specific vascular effects of the dye laser . J Invest Dermatol 1981; 77:305-310.Crossref 14. Morelli JG, Tan OT, Garden J, et al: Tunable dye laser (577 nm) treatment of portwine stains . Lasers Surg Med 1986;6:94-99.Crossref 15. Apfelberg DB, Kosek J, Maser MR, et al: Histology of portwine stains following argon laser treatment . Br J Plast Surg 1979;32:232-237.Crossref 16. Finley JL, Arndt KA, Noe J, et al: Argon laser-portwine stain interaction: Immediate effects . Arch Dermatol 1984;120:613-619.Crossref 17. Buecker JW, Ratz JL, Richfield DF: Histology of port-wine stain treated with carbon dioxide laser . J Am Acad Dermatol 1984;10:1014-1019.Crossref 18. Tan OT, Carney JM, Margolis R, et al: Histologic responses of port-wine stains treated by argon, carbon dioxide, and tunable dye lasers: A preliminary report . Arch Dermatol 1986;122:1016-1022.Crossref 19. Garden JM, Tan OT, Kerschmann R, et al: Effect of dye laser pulse duration on selective cutaneous vascular injury . J Invest Dermatol 1986;87:653-657.Crossref 20. Tan OT, Kerschmann R, Parrish JA: The effect of epidermal pigmentation on selective cutaneous vascular effects of pulsed laser . Lasers Surg Med 1985;4:365-374.Crossref 21. Tan OT, Kerschmann R, Parrish JA: Effect of skin temperatures on selective vascular injury caused by pulsed dye laser irradiation . J Invest Dermatol 1985;85:441-444.Crossref 22. Gilchrest BA, Rosen S, Noe JM: Chilling portwine stains improves the response to argon laser therapy . Plast Reconstr Surg 1982;109:278-283.Crossref 23. Apfelberg DB, Flores JT, Maser MR: Analysis of complications of argon laser treatment for portwine hemangiomas with reference to striped technique . Lasers Surg Med 1983;2:357-371.Crossref 24. Tang SV, Gilchrest BA, Noe JM, et al: In vivo spectrophotometric evaluation of normal, lesional and laser-treated skin in patients with port-wine stains . J Invest Dermatol 1983;80:420-423.Crossref 25. Noe JM, Barsky SH, Geer DE, et al: Port wine stains and the response to argon laser therapy: Successful treatment and the predictive role of color, age, and biopsy . Plast Reconstr Surg 1980;65:130-136.Crossref 26. Silver L: Argon laser photocoagulation of portwine stain hemangioma . Lasers Surg Med 1986;6:24-28.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

The Treatment of Port-wine Stains by the Pulsed Dye Laser: Analysis of Pulse Duration and Long-term Therapy

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References (30)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1988.01670060035012
Publisher site
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Abstract

Abstract • A flashlamp-pumped pulsed dye laser at 577 nm was evaluated in the treatment of port-wine stains. The degree of lesional lightening was compared following laser exposure with pulse durations of 20 and 360 μs. In addition, lesional therapy using the 360-μs pulse duration was evaluated for lightening and side effects following long-term patient observation and after repeated treatments of the same site. A total of 52 patients with port-wine stain were treated; their average age was 29 years, with eight patients less than 18 years, of whom 29 had comparative test site placement for the different pulse durations. Of these 29 patients, 25 demonstrated greater lightening at the 360-μs pulse duration test site. All 52 patients proceeded to receive full treatment placement with the 360-μs pulse duration, which resulted in an overall lightening of 42% after the initial treatment and 68% after re-treatment sessions. Forty-four percent of the patients had equal to or greater than 75% lesional lightening. Pretreatment anesthesia was unnecessary and only minimum posttreatment care was required. Mild adverse effects of epidermal change, depression, or pigmentary change appeared in only four cases and was limited to less than a 2% area in each of these lesions. These side effects did not recur when the lesions were re-treated at lower energy dosages. No posttreatment sclerosis or scarring appeared, even after multiple retreatment sessions to the same area, regardless of the anatomic location, color of the lesion, or age of the patient. The ability of the pulsed dye laser to increase blood vessel thermal damage selectivity has resulted in pulse duration—dependent changes that allow for favorable lesional lightening while significantly minimizing undesired side effects. (Arch Dermatol 1988;124:889-896) References 1. Solomon H, Goldman L, Henderson B, et al: Histopathology of the laser treatment of port-wine lesions . J Invest Dermatol 1968;50:141-146. 2. Goldman L, Dreffer R, Rockwell RJ, et al: Treatment of portwine marks by an argon laser . J Dermatol Surg 1976;2:385-388.Crossref 3. Apfelberg DB, Maser MR, Lash H: Extended clinical use of the argon laser for cutaneous lesions . Arch Dermatol 1979;115:719-721.Crossref 4. Cosman B: Experience in the argon laser therapy of portwine stains . Plast Reconstr Surg 1980;65:119-129.Crossref 5. Ohmori S, Huang C-K: Recent progress in the treatment of portwine staining by argon laser . Br J Plast Surg 1981;34:249-257.Crossref 6. Arndt KA: Argon laser therapy of small cutaneous vascular lesions . Arch Dermatol 1982;118:220-224.Crossref 7. Ratz JL, Bailin PL, Levine HL: CO2 laser treatment of port-wine stains: A preliminary report . J Dermatol Surg Oncol 1982;8:1039-1044.Crossref 8. Dixon JA, Gilbertson JJ: Argon and neodymium YAG laser therapy of dark nodular portwine stains in older patients . Lasers Surg Med 1986;6:5-11.Crossref 9. Van Gemert MJC, Hulsbergen Henning JP: A model approach to laser coagulation of dermal vascular lesions . Arch Dermatol Res 1981;270:429-439.Crossref 10. Anderson RR, Parrish JA: Microvasculature can be selectively damaged using dye lasers: A basic theory and experimental evidence in human skin . Lasers Surg Med 1981;1:263-276.Crossref 11. Anderson RR, Parrish JA: Selective photothermolysis: Precise microsurgery by selective absorption of pulsed radiation . Science 1983;220:524-527.Crossref 12. Van Gemert MJC, Welch AJ, Amin AP: Is there an optimal laser treatment for portwine stains? Lasers Surg Med 1986;6:76-83.Crossref 13. Greenwald J, Rosen S, Anderson RR, et al: Comparative histological studies of the tunable dye laser and argon laser: The specific vascular effects of the dye laser . J Invest Dermatol 1981; 77:305-310.Crossref 14. Morelli JG, Tan OT, Garden J, et al: Tunable dye laser (577 nm) treatment of portwine stains . Lasers Surg Med 1986;6:94-99.Crossref 15. Apfelberg DB, Kosek J, Maser MR, et al: Histology of portwine stains following argon laser treatment . Br J Plast Surg 1979;32:232-237.Crossref 16. Finley JL, Arndt KA, Noe J, et al: Argon laser-portwine stain interaction: Immediate effects . Arch Dermatol 1984;120:613-619.Crossref 17. Buecker JW, Ratz JL, Richfield DF: Histology of port-wine stain treated with carbon dioxide laser . J Am Acad Dermatol 1984;10:1014-1019.Crossref 18. Tan OT, Carney JM, Margolis R, et al: Histologic responses of port-wine stains treated by argon, carbon dioxide, and tunable dye lasers: A preliminary report . Arch Dermatol 1986;122:1016-1022.Crossref 19. Garden JM, Tan OT, Kerschmann R, et al: Effect of dye laser pulse duration on selective cutaneous vascular injury . J Invest Dermatol 1986;87:653-657.Crossref 20. Tan OT, Kerschmann R, Parrish JA: The effect of epidermal pigmentation on selective cutaneous vascular effects of pulsed laser . Lasers Surg Med 1985;4:365-374.Crossref 21. Tan OT, Kerschmann R, Parrish JA: Effect of skin temperatures on selective vascular injury caused by pulsed dye laser irradiation . J Invest Dermatol 1985;85:441-444.Crossref 22. Gilchrest BA, Rosen S, Noe JM: Chilling portwine stains improves the response to argon laser therapy . Plast Reconstr Surg 1982;109:278-283.Crossref 23. Apfelberg DB, Flores JT, Maser MR: Analysis of complications of argon laser treatment for portwine hemangiomas with reference to striped technique . Lasers Surg Med 1983;2:357-371.Crossref 24. Tang SV, Gilchrest BA, Noe JM, et al: In vivo spectrophotometric evaluation of normal, lesional and laser-treated skin in patients with port-wine stains . J Invest Dermatol 1983;80:420-423.Crossref 25. Noe JM, Barsky SH, Geer DE, et al: Port wine stains and the response to argon laser therapy: Successful treatment and the predictive role of color, age, and biopsy . Plast Reconstr Surg 1980;65:130-136.Crossref 26. Silver L: Argon laser photocoagulation of portwine stain hemangioma . Lasers Surg Med 1986;6:24-28.Crossref

Journal

Archives of Dermatology – American Medical Association

Published: Jun 1, 1988

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