Treatment of Port-Wine Stains With a Short Pulse Width 532-nm Nd:YAG Laser
January 2013 | Volume 12 | Issue 1 | Original Article | 66 | Copyright © January 2013
Kavitha K. Reddy MDa, Jeremy A. Brauer MDa, Munir H. Idriss MDb, Robert Anolik MDa,Leonard Bernstein MDa, Lori Brightman MDa, Elizabeth Hale MDa, Julie Karen MDa,Elliot Weiss MDa, Dirk Elston MDb, and Roy G. Geronemus MDa
aLaser & Skin Surgery Center of New York, New York, NY bAckerman Academy of Dermatopathology, New York, NY
Study Design: A prospective, controlled study was performed in 5 adults with PWS using a frequency-doubled Nd:YAG laser (Excel V; Cutera Inc, Brisbane, CA) in 4 quadrants, using spot sizes of 6 to 10 mm, fluences of 4.8 to 9 J/cm2, and pulse durations of 3 to 6 ms. An adjacent control area was not treated. Each was assessed immediately posttreatment for purpura and edema and at 1 month for PWS color, size, texture, and thickness. Skin biopsies obtained immediately after and at 1 month posttreatment were evaluated.
Results: All treatment quadrants displayed purpura. At 1-month follow-up, all treatment quadrants showed at least 1 grade of color improvement, from a minimum of 1% to 25% to a maximum of 51% to 75% improvement (12/20 quadrants with 1%-25% improvement, 3/20 with 26%-50%, 5/20 with 51%-75%, and 0/20 with 76%-100%). Histologic evaluation of treatment quadrants revealed vascular changes ranging 0.35 to 4 mm in depth. Immediately posttreatment, thrombi and extravasated red blood cells were observed in treatment quadrants. Histology at 1 month revealed decreased number and diameter of vessels in treatment quadrants (superficial vessels decreased by mean 1.1 vessels per section [13%], and diameter by 3.0 μm [47%], midlevel vessels decreased in number by 2.3 [20%], diameter by 2.42 μm [25%], and deep vessels decreased in number by 1.5 [83%], and diameter by 7.44 μm [88%]).
Conclusions: A single treatment with a short pulse width, frequency-doubled Nd:YAG laser resulted in safe and effective improvement of PWS, with up to 75% improvement in color observed at 1 month. Histologic evaluation demonstrated vascular injury at depths of 0.35 to 4 mm with a reduction in vessel number and size at multiple dermal levels.
J Drugs Dermatol. 2013;12(1):66-71.