Treatment of hypertrophic and resistant port wine stains with a 755 nm laser: a case series of 20 patients

Abstract

Background and objective: Port wine stains (PWS) are heterogeneous vascular malformations that can be treated with vascular-selective pulsed dye lasers (PDL). Hypertrophic PWS, especially in adults, are consistently less responsive to PDL. Furthermore, many PWS that respond well initially to PDL treatment may reach a response plateau, becoming unresponsive to further PDL treatments, a phenomenon termed "treatment resistance." Based on the theory of selective photothermolysis, vessels in such lesions may also be specifically targeted with a 755 nm laser that has selectivity for deoxyhemoglobin as well as oxyhemoglobin and increased depth of skin penetration.

Study design/patients and methods: Retrospective case review of 20 patients with either hypertrophic or PDL-resistant PWS treated with a 755 nm laser alone or in combination with other lasers, including PDL.

Results: Hypertrophic PWS showed significant lightening after treatment with a 755 nm laser in combination with PDL. Most PDL-resistant PWS showed moderate improvement after treatment with either a 755 nm laser alone or in combination with another laser, including PDL. Some lesions showed only mild improvement or did not respond. Serious side effects were infrequent. Most commonly encountered complications included pain, edema, bullae, crusting, and rare scarring.

Conclusions: Alexandrite 755 nm laser can be useful for the treatment of hypertrophic and treatment-resistant PWS in adult and pediatric patients. Complications are infrequent and predictable. Careful attention to using a fluence at or near the threshold for clinical response with this deeply penetrating laser is essential to prevent serious sequelae.

Copyright 2009 Wiley-Liss, Inc.

Figures

Fig. 1

Optical absorption spectrum of hemoglobin and deoxyhemoglobin, adapted from Dr. Scott Prahl: http://omlc.ogi.edu/spectra/hemoglobin.

Fig. 2

Hypertrophic PWS treated with Alexandrite laser with concurrent PDL (A,C: before; B,D: after treatment).

Fig. 3

PDL-resistant PWS treated with Alexandrite laser with concurrent PDL (A,B), or fractional 1,550 nm photo-thermolysis (C,D) (A,C: before; B,D: after treatment).