We are fortunate that in 2006 the treatment of port wine stains is generally effective and safe. Laser therapy is considered the treatment of choice for port wine stains although intense pulsed light sources can also be used for this purpose. Typically, a series of treatment sessions are required to obtain the maximum benefit of laser treatment in port wine stains. The degree of success in the treatment varies based upon the anatomical location of the port wine stain.
There are several lasers available for port wine stain treatment. The most commonly used is the pulsed dye laser. In the United States there are two commonly used devices which would include the V-Beam made by the Candela Corporation and the V-Star made by Cynosure. There is also a new combined pulsed dye and Nd:YAG laser made by Cynosure known as the Cynergy laser.
The data from the treatment of port wine stains is variable in terms of the clinical response. Published studies have shown an improvement ranging anywhere from 40% to 100% following a series of treatment sessions. More recently, improved technology and treatment protocols have allowed for a tendency towards more lightening and clearing of port wine stains.
There are some areas that are more difficult to treat than others. Typically, the central portion of the face and the lower arms, hands, lower legs and feet are much more resistant to therapy that other anatomical sites.
Treatment protocols and choice of technology may vary from physician to physician. In my experience, early intervention makes a significant difference. I prefer to initiate treatment during early infancy with treatment parameters that approximate those given to adults at relatively short intervals of three to four weeks. This “window of opportunity” during infancy allows for more complete clearing than is seen with older patients in all anatomical sites.
In almost all cases there is bruising following each treatment session that will last for approximately seven to fourteen days. The risks from these laser treatments are small. Textural and pigmentary changes following treatment are not common. I am often asked by parents to comment on the choices for anesthetics for port wine stain treatment.
For young infants, we typically will not give topical or general anesthesia unless we are dealing with a very large area. We defer the use of topical anesthesia until the child is one or two years of age, depending upon the choice of topical anesthetic. We sometimes use general anesthesia on a same-day surgery basis for those children who are uncooperative in the office setting or have large birthmarks that require a significant amount of time.
In my experience, most patients achieve approximately 75% to 80% clearing of the malformation, however, with earlier intervention during infancy we have seen more clearing and a greater number of patients with complete clearing than previously reported.
Children and adults undergoing laser treatment of their port wine stains often require significant support by their family and friends as this is a long process that usually leads to significant physical and psychological benefit.