The Assessment of Port Wine Stains in Children Following Multiple Pulsed-Dye Laser Treatments

Abstract

The purpose of this study was to compare 3 methods of assessment of pediatric port wine stains (PWSs) following multiple pulsed-dye laser (PDL) treatments; (i) parental evaluation, (ii) objective evaluation utilizing L*a*b* color measurement, and (iii) the visual inspection of serial photographs by blinded observers. Twenty-one children who had received at least 4 prior PDL treatments were prospectively enrolled. Following additional PDL treatment, 72.5% of the parental responses indicated a lighter PWS; 85% said that they would continue with further treatment. According to the assessments by 3 observers, only 33.3% to 61.9% (correlation coefficients: 0.41 and 0.54; P < 0.01) of the PDL treatments resulted in a perceived lightening. L*a*b* measurements were not significantly correlated with the observers' perceptions. L*a*b* assessment is not a clinically useful method to evaluate PDL response in the PWS previously treated. Relying solely on parental assessment may lead to overtreatment without a demonstrable benefit.

Clinical outcome measures and scoring systems used in prospective studies of port wine stains: A systematic review

“…Thirty-two percent (N = 28/85) of studies was randomized (i.e., randomization of treatments to different patients or to different sites within one patient and/or PWS) [ 11 , 31 , 36 , 39 , 41 – 59 , 61 , 62 , 81 , 92 , 103 ]. Of the uncontrolled (noncomparative) studies (N = 42/75 [ 63 – 69 , 71 – 80 , 82 – 91 , 93 – 102 , 104 – 108 ]), 11 were performed to correlate, develop, or validate an instrument or analysis technique (such as laser speckle imaging; intended for measuring lesion characteristics, treatment effects, or efficacy), 1 study investigated different clinical assessment methods, and 1 study correlated PWS characteristics and demographic parameters with treatment results. A majority of studies (60.5%) had a minimum follow-up duration of less than 2 months ( S2 Table ).…”

“…of studies was randomized (i.e., randomization of treatments to different patients or to different sites within one patient and/or PWS) [11,31,36,39,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]61,62,81,92,103]. Of the uncontrolled (noncomparative) studies (N = 42/75 [63][64][65][66][67][68][69][71][72][73][74][75][76][77][78][79][80][82][83][84][85][86][87]…”

Treatment Outcome Measurement Instruments for Port Wine Stains: A Systematic Review of Their Measurement Properties

“…Comprehensiveness was considered insufficient because, for example, hyperpigmentation was not included. No paper has published on the development or content validity of the other clinical OMIs [34, 38, 46].…”

Split‐face comparison of intense pulsed light with short‐ and long‐pulsed dye lasers for the treatment of port‐wine stains

“…Thus, the emitted wavelength band (median wavelength: 705 nm) was suitable for absorption in hemoglobin, while absorption in water and subsequent unselective epidermal heating could be reduced 20. Response was classified in percent clearance as accepted in the literature 20, 22, 24, 27, 28, 39, 42.…”