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Port-wine stains are a congenital,
progressive ectasia of the superficial cutaneous vascular plexus.
Over time, these superficial vessels can become ectatic and produce
a darkening and thickening of facial port-wine stains. Treatments,
which have included excision, dermabrasion, cryotherapy,
sclerotherapy, irradiation and placement of radioactive implants,
often resulted in pain and scarring. New laser techniques such as
the flash lamp pumped pulsed tunable dye laser (FLPDL) permit the
use of longer wavelengths and pulse widths to encourage heating of
hemoglobin and result in more effective thermal coagulation. The
intense pulsed-laser functions are based on principles of selective
photothermolysis that allow treatment of larger and more selective
vessels. These methods are effective in heating the upper as well as
the deeper vessels of port-wine stains and result in gentle, uniform
heating of the vessels and fewer cosmetically unacceptable results.
Raulin and associates evaluated the use of intense pulsed light
source (IPLS) in the treatment of port-wine stains.
A total of 37 patients with 40
port-wine stains were treated over a three-year period. Because of
the retrospective nature of the study, no uniform treatment
parameters were used. Three nonparticipating physicians reviewed
pretreatment and post-treatment photographs of the lesions to
evaluate lightening of the port-wine stains. The degree of clearance
was determined as a percentage of reduction in color relative to
normal skin. Results were ranked into one of four categories: 100
percent clearance, 70 to 99 percent clearance, 40 to 69 percent
clearance and less than 40 percent clearance.
Clearance of 70 to 99 percent of
pink port-wine stains occurred with an average of 2.8 treatment
sessions, red stains with an average of 1.4 treatment sessions, and
purple stains with an average of 4.2 treatment sessions. In five of
14 pink port-wine stains, 100 percent clearance was observed after
four treatment sessions. Two of 15 red port-wine stains completely
cleared after 1.5 treatment sessions. In purple port-wine stains,
100 percent clearance did not occur. In 77.7 percent of the total
treatment sessions, a single pulse was applied. Double pulses and
triple pulses were also used but less frequently.
Treatment results for previously
untreated port-wine stains (n = 28) included seven with complete
clearance, 14 with good clearance and six with only fair clearance.
Previously treated port-wine stains (n = 12) showed 100 percent
clearance in one case of red port-wine stain. Good clearance was
observed in two red and four purple port-wine stains, while one red
and three purple stains showed only fair results. One red port-wine
stain showed poor clearance. Therefore, results indicated complete
and good clearances in 75 percent of the previously untreated
port-wine stains in contrast to 58.3 percent of the previously
treated port-wine stains.
Side effects included immediate
erythema in all treatment sessions and immediate purpura (in 76
percent of treatment sessions) that persisted for a maximum of seven
days but typically lasted 24 to 72 hours. Swelling that lasted for
several hours was common. Blisters were rarely observed. Crusting
that resolved within one to two weeks was noted in 20 percent of the
treatment sessions. Hypo pigmentation and hyper pigmentation were
rare events and, if present, resolved within two to four months. No
scarring or textural changes resulted.
The authors conclude that IPLS is a
useful alternative, adjunctive or primary treatment of port-wine
stains. Combined with a low incidence of side effects and success in
treating FLPDL-resistant dark types of port-wine stains, the
reduction of vessel rupture and its associated purpura and hyper
pigmentation are significant benefits of the IPLS method. |
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