Update on flashlamp pumped pulsed dye laser treatment for port wine stains (capillary malformation) patients

Abstract

Background and aims: Currently, the method of choice for the treatment of port-wine stains is laser photocoagulation. Because of evolving treatment options, it is no longer enough for port-wine stains merely to be lightened through laser treatment. The best course of management consists of the most appropriate laser that will produce the most complete clearing of a lesion in the fewest treatment sessions with the least morbidity. The goal is generally accomplished with the use of yellow-light lasers. Materials (Subjects) and Methods: Absorption of laser energy by melanin causes localized heating in the epidermis, which may, if not controlled, produce permanent complications such as hypertrophic scarring or dyspigmentation. Refinements of the results can be achieved by using the flashlamp-pumped pulsed dye laser (FLPDL) in conjunction with the cryogen spray cooling (CSC) system. In our related studies, the infrared thermal image instrument is used for doctors in determining the optimum laser light dosage and preventing the side effects caused by FLPDL. Topic application of angiogenesis inhibitor (Imiquimod) in conjunction with pulsed dye laser treatment for the PWS patients has been assessed for improvement of FLPDL treatment.

Results: We present the clinical effect of FLPDL, and the efficacy and safety of cooled laser treatment of PWS birthmarks. Our clinical outcome in the laser treatment of patients with PWS has been achieved to maximize thermal impact on targeted vessels, while minimizing adverse complications.

Conclusions: CSC in conjunction with FLPDL can improve the treatment of PWS. The infrared image instrument is helpful for doctors in determining the optimum laser light dosage. Topic application of angiogenesis inhibitor (Imiquimod) in conjunction with laser treatment for the PWS patients is promising in the near future.

Keywords: Port-wine stains (PWS); angiogenesis inhibitor; cryogen spray cooling (CSC); flashlamp-pumped pulsed dye laser (FLPDL); infrared thermal image instrument.

Figure 1:

Plot of a patient's facial skin temperature before (blue dot line) and after PDL treatment (red dot line) for PWS with infrared thermal image instrument.

Figure 2:

A four-year-old Asian female with a PWS on her left fcae: A) prior to laser therapy; and B) Eight Months after two treatments with CSC-LT (585 nm) using spot size of 7 mm with an energy density of 9 J/cm². The result was evaluated as an excellent blanching response.

Figure 3:

A six-year-old Asian female with a PWS on her face: A) prior to laser therapy; and B) Six months after two treatments with CSC-LT (585nm) using spot size of 7 mm with an energy density of 9 J/cm². The result was evaluated as an excellent blanching response.