A Split-Face Study of Dual-Wavelength Laser on Neck and Facial Port-Wine Stains in Chinese Patients
November 2015 | Volume 14 | Issue 11 | Original Article | 1336 | Copyright © 2015
Han-deng Tu MD,a,b,c Yuan-hong Li MD PhD,b Hong-fu Xie MD,a Jia-mei Xiong MD,c Bing Wang MD,b Xue-gang Xu MD,b La-ga Tong MD,b LiLi MD,b Michael H. Gold MD,d and Hong-Duo Chen MDb
aDepartment of Dermatology, Xiangya Hospital, Central South University, Changsha, China
bNo. 1 Hospital of China Medical University, Liaoning, China
cJiangxi Province Dermatosis Special Hospital, Jiangxi, China
dGold Skin Care Center, Nashville, TN
BACKGROUND: Although pulsed dye laser (PDL) has long been regarded as the gold standard in treating port-wine stain (PWS), advanced PWS with deeper coloration may display resistance because of limited penetration depth of 585 or 595-nm light. Recently, a dual-wavelength laser system has been reported to achieve pronounced fading in many patients.
OBJECTIVE: The objective was to evaluate the efficacy and safety of a dual-wavelength laser device in treatment of neck and facial PWS in a direct side-by-side comparison.
METHODS: Sixteen Chinese patients with neck and/or facial PWSs were enrolled in the study. All lesions were randomly divided into two area, treated area and adjacent untreated area. Five successive treatments using a dual-wavelength laser system (595-nm PDL combined with 1,064-nm Nd:YAG laser) were delivered on treated areas at 4- to 6-week intervals. The adjacent area was not treated as self control. Two blinded dermatologists evaluated the clinical changes by comparing the before and after photos. Erythema index (EI) values were measured with a non-invasive instrument.
RESULTS: After five sessions of treatment, over 62.5% (10/16) patients achieved more than 50% (moderate or significant) improvement. The efficacy maintained at the 3-month follow-up visit. The values of EI on treated area showed a significant decrease. Adverse effects of treated area were limited.
CONCLUSION: Using this split-face module, the dual-wavelength laser system is proved to be effective and well tolerated in treating neck and facial PWSs in Chinese patients. Adverse effects were minimal and acceptable.
J Drugs Dermatol. 2015;14(11):1336-1340.
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PWS, also regarded as “nevus flammeus”, are benign congenital vascular malformations consisting of ectatic blood vessels, situated predominantly in the upper dermis.1 Unlike hemangioma, PWSs do not have a tendency to involute. These birthmarks occur in 0.3% to 0.5% of newborns and initially appear as flat, pink to red patches that may gradually progress into hypertrophic, red to purple lesions with age.2-4 Histologically, PWS demonstrate ectatic dilation of a normal number of post capillary venues of diameters ranging from 10 to 150 μm and predominantly involve the papillary dermis.5, 6 They commonly occur on the head and neck (83%),7 which can be associated with significant cosmetic disfigurement and psychological distress, especially when involving these exposed areas.8,9 So early treatment is recommended.
Although PDL is still the mainstay of treatment for majority of PWSs, not all lesions respond well. Complete clearance is achieved in < 10%, and roughly 20% of lesions fail to lighten at all.10 In some patients, PWSs become refractory to PDL. Limited penetration depth of yellow light emitted by PDL may well explain this. The depth of PWS ranges from 1 to 5 mm, which cannot be reached alone by 595-nm PDL.11 In order to improve outcomes in advanced deep red or purple PWS or even with overlying nodularity, treatment with a more deeply penetrating millisecond-pulsed 1,064-nm Nd: YAG laser has been studied.12,13 However this wavelength has less hemoglobin absorption; thus, higher laser fluences are required to achieve adequate capillary heating. Additionally, the laser has a narrow therapeutic window, which may result in increasingly risk of epidermal and dermal side effects, such as unacceptable scarring. In order to improve efficacy and minimize side effects, hybrid lasers were advocated. Some research have found that combined PDL and Nd: YAG laser were effective for PWSs.14,15 However, controlled split-face clinical trials of PWSs treated with dual-wavelength laser are rare in literatures. The objective of this clinical study was to evaluate the efficacy and safety of a novel device that delivers sequential timed pulses of 595- and 1,064-nm wavelengths through a single handpiece in the treatment of neck and facial PWSs in Chinese patients.