Laser therapy of port wine stains

A portwine stain is a vascular cutaneous abnormality formed by a network of dilated capillaries in the dermis. In this lesion of congenital origen, the overlying epidermis is normal and relatively clear, making the aberrant network of capillaries visible with a characteristic wine-like colour. Before the introduction of lasers in medicine, these lesions were essentially untreatable, although many techniques were tried but none gave consistently satisfactory results. In the beginning Argon laser was the system of choice for treating PWS. The aims of this laser which produced blue/green light in the wavelength range of 488 to 514 nm was to obliterate the ectatic blood vessel in order to blanch the PWS. The exposure time of the beam on the skin was typically in the order of 200 millisecons with a spot size of one millimetre. The laser beam was moved over the skin by free hand or by one of a number of computer assisted scanning devices. Within the past few years a number of lasers have been introduced for the treatment of PWS including frequency doubled NgYrg, continuous Argon Pump Dye Laser, Copper vapour and Pulsed Dye lasers. Within this group only the Pulsed Dye laser produces parameters which meet the ideal found by research done on mathematical models. The wavelength of 585 nm, of 5 millimetres, pulse duration of 450-600 microseconds and energy from 5-10 J/cm(2). These parameters are at the moment considered the most suitable based upon the findings achieved by clinical and laboratory trials. These ideal programmation should cause the destruction of vessels of the dermis and lead to the recovery of the skin's normal colours. The Pulsed Dye laser appears to produce the best results in infants suffering from pale PWS, and, therefore, it appears nowadays that it is possible to recommend that treatment of very young children could be successfully done with this system. If recommendations are strictly followed, and energy density is maintained in less than 8 J/cm(2) there appears to be a negligible chance of scarring.