Port-wine stain (PWS) birthmarks are congenital, low-flow vascular malformations of the skin. Lasers are the modality of choice for the treatment of PWS birthmarks, and for most patients the pulsed-dye laser in conjunction with epidermal cooling offers the greatest efficacy and safety. Other light devices, including the 532-nm frequency-doubled Nd:YAG laser, intense pulsed light, 1064-nm Nd:YAG laser, and combined 1064/532-nm system, may be useful during a treatment course for resistant PWS. Laser treatment results in blanching of most lesions, although complete resolution may not occur and some resistant PWS birthmarks respond minimally, if at all. Factors limiting laser treatment include variable vascular geometry, inadequate damage of some vessels, and lesional posttreatment recurrence as a result of neovascularization. Alternative or adjunct treatment options that address these limitations should be explored, including noninvasive real-time imaging to optimize the selection of treatment settings, photodynamic therapy, and perioperative use of antiangiogenic compounds.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Absorption spectra for melanin (melanosome from Steven Jacques, PhD; available at: http://omlc.ogi.edu/spectra/melanin/index.html; accessed May 10, 2005), oxyhemoglobin, and deoxyhemoglobin (hemoglobin from Scott Prahl, PhD; available at: http://omlc.ogi.edu/spectra/hemoglobin/summary.html; accessed May 10, 2005). The ordinate is on the log scale.
Photographs of a woman aged 42 years with a port-wine stain (PWS) birthmark of the upper lip before (A) and after (B) 4 treaments with the pulsed dye laser in combination with cryogen spray cooling. Blanching of the PWS was graded as 75% or greater by reviewers.
Photographs of a woman aged 23 years with a facial port-wine stain (PWS) birthmark before (A) and after (B) 3 pulsed-dye laser treatments in combination with cryogen spray cooling. Blanching of the PWS was graded as 75% or greater by reviewers.
Photographs of a man aged 41 years with a facial port-wine stain (PWS) birthmark before (A) and after (B) 4 treatments with a pulsed-dye laser in combination with cryogen spray cooling. Blanching of the PWS was graded as 25% to 49% by reviewers.
Confocal image from an untreated port-wine stain birthmark. Capillaries are stained with panendothelial marker, CD31 (red), and nerves are stained with panneuronal marker, protein gene product 9.5 (green). Variability is seen in the size and depth of the vessels (courtesy of Mona Selim, MD, William R. Kennedy, MD, and Brian D. Zelickson, MD).
Laser speckle images of an upper extremity port-wine stain birthmark treated with a pulsed-dye laser. Images were acquired immediately before (A) and 10 minutes after (B and C) treatment. A marked reduction in perfusion is apparent after treatment at 2 sites; however, focal regions of perfusion are evident. The color key at right is in arbitrary units.
Hematoxylin-eosin–stained biopsy specimen taken from the edge of a treated port-wine stain (PWS) birthmark immediately after pulsed-dye laser exposure (original magnification ×200). Extensive thermal damage and enlarged spaces (destroyed vessels) in the treated area are seen on the right side of the image. Clinically, significant purpura was noted after treatment, but minimal PWS blanching was noted at follow-up.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Facial Plastic Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 48
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.