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The pulsed-dye laser (PDL) has been the gold-standard treatment for port wine stain (PWS) for 20 years. To determine the permanence of PDL-induced fading, investigators in the Netherlands took follow-up color measurements of participants in a prior prospective study of PDL treatment for PWSs. The earlier color measurements had been made before treatment and after the first five PDL treatments of PWSs of the head or neck. The treatment parameters were wavelength of 585 nm at 6 to 8 J/cm2, with a pulse duration of 0.45 ms, and a 5-mm or 7-mm spot size. Color measurements (lightness × values from green to red × values from blue to green) were made by comparing the darkest part of the PWS to contralateral normal skin. Of the original 89 patients, 13 could not be located, 15 declined to participate, and 10 were excluded because they received subsequent laser treatment at another facility. Of the remaining 51 patients, 45 had undergone a median of seven additional PDL treatments at the study facility.
The median color difference between the PWS and normal skin was 15.2 before treatment, 8.9 after five PDL treatments, and 12.4 at the median 9.5-year follow-up. Redarkening was more prominent in the six patients who had not undergone additional PDL than in those who had. In responses to a patient questionnaire, 59% indicated satisfaction with the treatment results at follow-up, and 41% indicated dissatisfaction; 6% reported that their PWSs had lightened since concluding treatment, 35% reported that they had darkened, and 59% reported no change.
Huikeshoven M et al. Redarkening of port-wine stains 10 years after pulsed-dye–laser treatment. N Engl J Med 2007 Mar 22; 356:1235-40.
Comment
As in previous case reports, these PWSs gradually recurred after PDL treatment. Possible explanations include continued dilation of remaining ectatic vessels or gradual dilation of the replacement vessels, which also lack autonomic innervation. The degree of redarkening in this study may be exaggerated because the researchers measured the darkest part of the PWS, which is often the most treatment-resistant. In clinical practice, the rest of the lesion often remains fully or mostly faded. This may be why the patients found the results more satisfying than the color measurements would suggest. The new generation of PDLs — with their larger spot sizes, longer wavelengths, varied pulse durations, and epidermal cooling — should achieve better initial fading and, possibly, longer delayed recurrence.