Treatment of Children with Port-Wine Stains Using the Flashlamp-Pulsed Tunable Dye Laser

TLDR

The flashlamp‑pulsed tunable dye laser used 577‑nm light with 360‑µs pulses, matching dermal vessel thermal relaxation to selectively target oxyhemoglobin while minimizing nonspecific thermal damage. In 35 children, complete clearance of port‑wine stains was achieved after an average of 6.5 treatments, with younger children requiring fewer sessions, normal skin texture in 94.3%, and only transient hyperpigmentation in 57%. Published in N Engl J Med 1989;320:416–21.

Abstract

Thirty-five children, three months to 14 years of age, with disfiguring port-wine stains were treated with a flashlamp-pulsed tunable dye laser. All had complete clearing of the stains after an average of 6.5 laser treatments to each lesional area; skin over bony prominences required approximately half as many sessions as skin on the cheek. Children less than seven years old required fewer sessions (mean ±SD, 5.8±1.1) than older children (7.1±1.1; P<0.05). Treated skin was identical in texture and color to adjacent normal skin in 33 (94.3 percent) of the children, whereas 2 (5.7 percent) had small, isolated, depressed scars in areas accidentally traumatized soon after laser treatment. The only other side effect was transient hyperpigmentation, which occurred in 20 patients (57 percent). These results can be attributed to two distinguishing characteristics of the flashlamp-pulsed tunable dye laser: an emission wavelength of 577 nm, theoretically ideal for selective absorption by the intravascular target oxyhemoglobin, and a pulse duration of 360 μsec, which closely matches the thermal relaxation time for dermal blood vessels and hence avoids diffuse nonspecific thermal necrosis with subsequent scarring of the treated skin. (N Engl J Med 1989;320:416–21.)