At our institutions, we have multiple lasers including the Gemini, four Candela pulsed dye lasers (SPTL1-b, ScleroPLUS, C-Beam and V-Beam, and Perfecta), Lumenis VersaPULSE and the Cynosure dual-wavelength Cynergy Multiplex on our permanent equipment inventories.Ĭommonly, several devices are used during an extended treatment protocol in order to destroy vessels of different sizes. Both parameters affect the depth and degree of heating in PWS vessels of different sizes. (Linda Rozell-Shannon, 11/8/07).Īccording to Nelson and Geronemus, “Multiple devices are now available for PWS treatment, each with its own unique wavelength and pulse duration. So, the stain appears but it is comprised of new vessels, not necessarily the ones that were treated by the laser. New, deeper vessels are migrating to the surface of the skin. It is our belief that the more lesion clearing obtained, the less likely the chance of recurrence.” NOTE: This statement now has been qualified to mean that the vessels that are treated may not recur but new ones will find their way to the surface of the skin and cause “some” stain to appear like the PWS has returned. Consequently, the ability to vary the parameters with each treatment session and amongst different patients results in better clinical results. PWS blood vessels are heterogeneous in terms of their sizes and depths. Moreover, other laser parameters such as wavelength, pulse duration and spot size were also “fixed” and could not be adjusted to tailor the needs of each individual patient’s lesion. Very likely, the light dosages in current use from lasers that are available today are a factor of more than two higher than those used in the Huikeshoven study. This device did not utilize dynamic cooling, which allows the clinician to use safely much higher light dosages. Unfortunately, the laser technology utilized by Huikeshoven’s group was the Candela SPTL1b, which is now considered obsolescent for port wine stain (PWS) laser therapy. “We reviewed “Redarkening of Port-Wine Stains 10 Years after Pulsed-Dye-Laser Treatment” by Huikeshoven et al (NEJM 2007 356:1235-1240) with great interest and would offer our comments. While the laser does not “cure” the PWS, it offers the most hope for clearance, for keeping the skin from thickening and cobbling and for maintaining the best aesthetic outcome for the patient (comment by Linda Rozell-Shannon, President and Founder of the Vascular Birthmarks Foundation, 11/8/07). It is important to understand this because many people believe that PWS will always come back and, therefore, they should not have laser treatment. To summarize what was presented, after a PWS is treated using the pulsed dye laser, the vessels that are targeted by the laser will not necessarily come back, but rather new, deeper vessels will work their way up to the top of the skin thus making “some” stain appear. At a prior VBF conference in Irvine, several physicians spoke about the pathology, progression and treatment of PWS. Roy Geronemus was published in the New England Journal of Medicine in response to an article about the recurrence of Port Wine Stains (PWS) after pulsed dye laser treatment. Vascular Birthmarks Legislative Initiative.American Academy of Dermatology Guidelines of Care.American Academy of Pediatrics Guidelines for Hemangiomas.Any duplication or distribution of the information contained herein is strictly prohibited. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. Links to other sites are provided for information only – they do not constitute endorsements of those other sites. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. This site complies with the HONcode standard for trustworthy health information: verify here. Learn more about A.D.A.M.'s editorial policy editorial process and privacy policy. is among the first to achieve this important distinction for online health information and services. follows rigorous standards of quality and accountability. is accredited by URAC, for Health Content Provider (URAC's accreditation program is an independent audit to verify that A.D.A.M.
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