The pulsed dye laser (PDL) revolutionized the treatment of port wine stains (PWS) when it was introduced 20 years ago. The current trend is to treat lesions during the pre-school period in order to minimize psychosocial complications. A major development has been the modification of first-generation PDLs to include longer wavelengths (595−600 nm), more power and better skin cooling.
This has led to more effective clearance of PWS, including those that have been resistant to first-generation PDLs. Despite this, at least 20% of PWS fail to respond, and one-third re-darken in the 10 years after treatment.
Strategies under investigation that may overcome these inadequacies include reducing revascularization after treatment, the use of suction devices, longer wavelength lasers such as the alexandrite (755nm) and Nd:YAG(1064nm) and dual wavelength lasers such as the Cynergy Multiplex (Cynosure, MA, USA), which emits a pulse at 585 nm followed by a pulse at 1064 nm. This laser has also proved useful in the treatment of facial and leg vein telangiectasia.
Although the PDL can treat facial telangiectasia, the purpura with short pulses is undesirable. This can be overcome by using non- purpuric settings with longer pulse durations, intense pulsed light sources (IPLs) or the KTP laser. Newer IPLs give greater control of light dosimetry with good clinical results reported in a number of vascular conditions.
Fractionated lasers may be applicable for some vascular disorders but clinical research is limited at this time.
Lasers Surg Med. 2008;40(9):605-10.
Pilot study examining the combined use of pulsed dye laser and topical Imiquimod versus laser alone for treatment of port wine stain birthmarks.
Chang CJ, Hsiao YC, Mihm MC Jr, Nelson JS.
Lasers Surg Med. 2009;41(6):427-32.
Treatment of hypertrophic and resistant port wine stains with a 755 nm laser: a
case series of 20 patients. Izikson L, Nelson JS, Anderson RR.
Lasers Surg Med. 2010;42(2):105-12.
Long-term blood vessel removal with combined laser and topical rapamycin
antiangiogenic therapy: implications for effective port wine stain treatment.
Jia W, Sun V, Tran N, Choi B, Liu SW, Mihm MC Jr, Phung TL, Nelson JS.
Lasers Surg Med. 2010;42(2):93-104. Intense pulsed light (IPL): a review. Babilas P, Schreml S, Szeimies RM, Landthaler M.
About sk:n clinics:
Established in 1990, sk:n has 20 years of experience and has carried out over 3 million treatments on more than 300,000 clients. sk:n clinics was the first network of clinics to be registered on the Treatments you can Trust register from the IHAS and is the UK's leading provider of affordable and innovative laser and rejuvenation treatments, including laser hair removal, injectable treatments, botox and acne treatments. Each of its 36 clinics nationwide is registered with the Care Quality Commission and each highly-trained team is headed up by an expert medical director. 10% of all UK dermatologists work for or with sk:n.
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