Light‐based treatment of pediatric port‐wine birthmarks

Abstract

Port-wine birthmarks (PWBs), often referred to as port-wine stains or capillary malformations, are progressive malformations composed of capillaries and post-capillary venules. They occur in up to 0.3% of newborns, present at birth as a pink to red patch, and often involve cosmetically sensitive areas including the face. 1 Over time, many PWBs darken in color, acquire secondary changes, including nodules and pyogenic granulomas, and develop soft-tissue hypertrophy that may involve underlying structures. 2,3 PWBs are now known to be caused by somatic mosaic mutations in genes that control cell-cycle regulation, including GNAQ, GNA11, PiK3CA, and others that are also implicated in cell-cycle signaling. 4 This finding has transformed our fundamental understanding of their pathophysiology, as these genes share oncogenic pathways that result in synchronous, tightly regulated cellular proliferation and growth. PWB can be isolated, or syndrome-associated, including Sturge-Weber syndrome (SWS), phakomatosis pigmentovascularis (PPV), or PiK3CA-related overgrowth syndromes (PROS). Genotypephenotype correlations exist for the most common mutations in vascular stains (GNAQ, GNA11, and PiK3CA hot spot, Figure 1). 4 While detailed mechanisms are not yet characterized, causative gain-offunction somatic mosaic mutations may explain the progressive development of nodularity, soft-tissue hypertrophy, and secondary vascular change of PWBs. [4][5][6] Given the progressive disfigurement associated with PWBs, parents often seek early treatment with laser and other light-based modalities. Early treatment of PWBs reduces the likelihood and severity of disfigurement and psychosocial morbidity. 3,7 In particular, the development of vascular-selective lasers led to a therapeutic shift in the management of PWBs and remains the first-line standard of treatment. In this article, we review principles of light-based treatment for pediatric port-wine birthmarks. | Selective photothermolysisThe use of lasers to treat vascular lesions relies on the theory of selective photothermolysis (SP); chromophores or light-absorbing targets can be targeted, heated, and damaged with minimal injury to the surrounding structures (Figure 2A). 8 For PWBs, the light-absorbing targets are oxyhemoglobin (absorption peaks at 418, 542, and 577 nm), deoxyhemoglobin (absorption peak between 750 and 800 nm), or methemoglobin (absorption at 620 nm, Figure 2B). 9 Three elements are necessary to achieve desired clinical effects in PWB lesions. First, the wavelength chosen must be preferentially

Long‐term follow‐up outcomes of laser‐treated port wine stain patients: A double‐blinded retrospective study

“…Laser-associated purpura is a common complication. 12 This was also observed in our study. It is the most favorable endpoint for PDL, which was used in the majority of our patients.…”

“…Other light‐based therapeutic options, such as long‐pulse alexandrite or long‐pulse Nd:YAG, which provide greater penetration depth, may have a role in treating these lesions. However, these lasers carry a higher risk of causing scars and pigmentation, which can lead to unfavorable outcomes 12,13 . In terms of distribution, many studies have reported that the centrofacial area and S2 are associated with poor outcomes 14 .…”

“…However, these lasers carry a higher risk of causing scars and pigmentation, which can lead to unfavorable outcomes. 12,13 In terms of distribution, many studies have reported that the centrofacial area and S2 are associated with poor outcomes. 14 Here we observed that lesions on the upper eyelid and nasal tip were associated with poor outcomes.…”

Update on lasers in pediatric dermatology: how primary care providers can help patients and families navigate appropriate treatment options and timelines

“…The interval between treatments varies within the literature, with most studies reporting intervals from 2 to 6 weeks. There does not seem to be a considerable improvement in clearance rates with more frequent treatments, but populations of skin of color may demonstrate greater adverse effects with treatment intervals of 2 weeks [4].…”

Safety and Feasibility of Low Fluence Intense Pulsed Light for Treating Pediatric Patients with Moderate-to-Severe Blepharitis

“…Intense pulsed light (IPL) therapy has been studied in adults to improve meibomian gland (MG) secretion, reduce eyelid telangiectasias, and eradicate blepharitic Demodex mainly through the photothermal effect [ 11 ]. From toddlers to adolescents, IPL has been frequently employed in the dermatology field concerning the removal of facial hair and port-wine birthmark, the impediment of scar formation, with no remarkable side effects documented [ 12 , 13 , 14 , 15 ]. However, few published articles have discussed the feasibility of IPL in pediatric blepharitis.…”