Dermatología Pediatrica

Some lesions may need further treatments.The pulsed dye laser (PDL), now in its third generation, is the treatment of choice for port wine stains (PWSs). Dramatic, if not total, fading is possible in most patients. What is the chance that a laser-treated PWS will recur? In this retrospective study from the U.K., 110 pediatric patients with PWS treated with the 585-nm PDL were evaluated for lesion reemergence. Of the 110 patients, 16 were excluded from analysis (because of missing records, incomplete treatment, loss to follow-up, or lack of response).Treatment was stopped when the lesion had faded completely, the patient was happy with the result, or the physician felt that the response was so good that further treatment was not indicated. Reemergence of the PWS necessitating additional PDL treatment occurred in 15 of the 94 patients (16%), 17 to 59 months (mean, 31 months) after the initial PDL series.

Comment: Contrary to initial reports of 100% fading in 100% of patients treated with PDL, total fading is seen in only a minority of patients, and a considerable number of lesions re-darken. This is consistent with the fact that the blood vessels in the PWS-affected skin lack the autonomic innervation that gives blood vessels their tone. Without autonomic nerve support, the vessels become ectatic. Any vessels remaining after PDL treatment, even small, apparently normal vessels, can be expected to dilate over time, leading to re-darkening of the PWS. The rate of recurrence after treatment with the newer PDLs - which have longer pulse durations, higher energy fluences with cooling, and large spot sizes - remains to be determined. Treatment is still worthwhile for most patients, as only a minority of lesions recur, and these recurrent lesions tend to be much lighter than the initial PWS. Retreatment every few years can keep patients free of clinically visible PWSs.- George J. Hruza, MDPublished in Journal Watch Dermatology September 22, 2006