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Description and Analysis of Treatments for Port-wine Stain Birthmarks

Kristen M. Kelly, MD; Bernard Choi, PhD; Samantha McFarlane, MD; Alison Motosue, MD; Byungjo Jung, PhD; Misbah H. Khan, MD; Julio C. Ramirez-San-Juan, PhD; J. Stuart Nelson, MD, PhD
Arch Facial Plast Surg. 2005;7(5):287-294. doi:10.1001/archfaci.7.5.287.
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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.

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Figures

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Figure 1.

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.

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Figure 2.

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.

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Figure 3.

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.

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Figure 4.

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.

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Figure 5.

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).

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Figure 6.

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.

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Figure 7.

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.

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