Pulsed dye laser-resistant port-wine stains: mechanisms of resistance and implications for treatment

Abstract

Port-wine stains (PWS) are among the most common congenital vascular malformations. Unlike capillary haemangiomas, these lesions do not involute spontaneously but rather become progressively more disfiguring as the patient ages. While benign in nature, the cosmetic deformity and attendant psychological and emotional distress prompt the majority of those afflicted to seek treatment. The pulsed dye laser (PDL) has long been considered the treatment of choice for these vascular lesions; however, very few patients achieve total clearance with PDL therapy and a significant number of lesions fail to respond at all. In order to address these recalcitrant cases, the mechanisms that contribute to treatment resistance must be understood and novel laser and light therapies must be employed. This review will address what is currently known about lesion-specific characteristics of PDL-resistant PWS as well as discuss current and future treatment options.

Photodynamic therapy in dermatology beyond non-melanoma cancer: An update

“…Pulsed-dye laser (PDL) is the current standard treatment for PWS. However, about 20% of PWS are resistant to PDL [50]. Vascular-targeted PDT with an intravenous injection of a hematoporphyrin derivative followed after a short time by irradiation might be an alternative for the treatment of PWS (Fig.…”

Successful Treatment of Unilateral Klippel-Trenaunay Syndrome With Pulsed-Dye Laser in a 2-Week Old Infant

“…15,16 Resolution of PWS, as defined by persistent blanching of the lesion, is reported in less than 10%-20% of cases. 12,[17][18][19][20] Early intervention is indicated to prevent the development of hypertrophy and nodularity, which has been shown to increase treatment resistance. 12,21 Thickened PWS lesions at older age have been associated with increased therapeutic failure.…”

Clinical efficacy of the 595 nm pulsed dye laser in the treatment of childhood superficial hemangioma – analysis of 10-year application in Chinese patients

“…Few studies have specifically addressed this result in the treatment of SH by PDL. We concluded that SH may be in remission through several treatment times, but they may be suspend to respond with further PDL treatment, such as port wine stains (16).…”