The treatment of port-wine stains by the pulsed dye laser. Analysis of pulse duration and long-term therapy

Garden, Jerome M.

doi:10.1001/archderm.124.6.889

Cited by 106 publications

(90 citation statements)

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“…By proper selection of pulse duration ( p ) and wavelength (), thermal energy remains confined to the targeted vasculature. These therapies have proven effective [2][3][4][5][6] ; however, multiple treatments are often required, and complete clearing of the lesion is not always achieved, 6 especially in patients with large-diameter vessels and extensive vasculature that extends deep within the dermis. 7 Incomplete clearing of the lesion may be due to insufficient heat generation within the targeted vasculature, which is affected by pulse duration ( p ), wavelength (), and radiant exposure (D 0 injury per treatment session, ultimately leading to a decreased number of treatments required for successful clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Although high radiant exposures are needed to increase dermal fluence levels in darkskinned patients, 9,10 the risk of epidermal damage also increases. 6,10,11 Either cooling of superficial skin layers needs to be increased or fluence levels within the epidermis need to be decreased. Recent studies 27,31,32 have focused on increasing the heat transfer rates and the total heat removal during CSC by studying nozzle design and cryogen delivery methods.…”

Section: Dark-skinned Individuals (Group 3)mentioning

confidence: 99%

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Effects of Cryogen Spray Cooling and High Radiant Exposures on Selective Vascular Injury During Laser Irradiation of Human Skin

Tunnell¹,

Chang²,

Johnston³

et al. 2003

Arch Dermatol

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Section: Discussionmentioning

confidence: 99%

Section: Dark-skinned Individuals (Group 3)mentioning

confidence: 99%

Effects of Cryogen Spray Cooling and High Radiant Exposures on Selective Vascular Injury During Laser Irradiation of Human Skin

Tunnell¹,

Chang²,

Johnston³

et al. 2003

Arch Dermatol

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“…Nevertheless, the semiquanti- tative clinical evaluation facilitates data analysis and has been used previously as the basis for drawing conclusions. 11,16 Furthermore, a precise relocation of the treated areas, a precise placement of the ultrasonic probe, and variations in blood flow and dermal water content may constitute important factors. All preoperative and postoperative measurements were performed when the children were given general anesthesia.…”

Section: Commentmentioning

confidence: 99%

Changes in Skin Redness, Pigmentation, Echostructure, Thickness, and Surface Contour After 1 Pulsed Dye Laser Treatment of Port-wine Stains in Children

Hædersdal¹,

Efsen²,

Gniadecka³

et al. 1998

Arch Dermatol

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Background:The pulsed dye laser is the treatment of choice for children with port-wine stains (PWSs). Evaluation of treatment outcome and adverse effects is traditionally based on subjective clinical scoring systems. We intend to objectify treatment results and adverse reactions after 1 treatment with the pulsed dye laser.Design: A before-and-after trial using skin reflectance to detect changes in skin redness and pigmentation, ultrasonography to evaluate changes in echostructure and skin thickness, and 3-dimensional surface contour analysis to detect changes in surface texture.Patients: Twelve children with PWSs.Setting: A university dermatological department. Results:The skin reflectance-determined change in skin redness correlated with the clinical response (r=0.46, PϽ.002). The percentage of reflectance-determined lightening was equal for pink, red, and dark red PWSs (median, 42.9%). Skin pigmentation increased after laser treat-ment (PϽ.007). Ultrasonography revealed lower dermal echogenicity of preoperative PWSs than of postoperative PWSs (PϽ.007) and healthy skin (PϽ.001). An increase in echogenicity reflected a decrease in the dermal water (blood) content. Variations were found in the dermal localization of the PWS. Skin thickness was significantly higher in the PWS before treatment than after (PϽ.001). The preoperative lesional thickness correlated inversely with the ultrasound-assessed treatment response (r=0.35, PϽ.04). The surface contour parameters decreased significantly after laser treatment, indicating a flattening of the skin surface. The contour changes correlated positively with treatment response. By clinical evaluation, no hypopigmentation or texture changes were detected. Conclusion:The evaluation of treatment outcome and adverse effects is refined by the use of skin reflectance, ultrasonographic, and surface contour analysis.

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“…Deep purple, thick or nodular PWSs respond best to continuous-wave or quasi-continuous-wave lasers [1, 2, 3, 4, 5]. However, a complete clearing of the lesions is infrequent and abut 20% of PWSs are nonresponsive to laser treatment [6, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

Epiluminescence Microscopy for Port-Wine Stains: Pretreatment Evaluation

Procaccini¹,

Argenziano²,

Staibano³

et al. 2001

Dermatology

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Background: Port-wine stains (PWSs) are characterized by an increased number of ectatic vessels. The treatment of choice is the use of some lasers such as pulsed dye lasers. However, some lesions are nonresponsive to laser treatment. Perhaps the vessels’ depth and diameter and the thickness of the vessel wall are important factors influencing the effectiveness of the laser treatment. Methods: To investigate whether epiluminescence microscopy (ELM) could be useful in determining the effectiveness of laser treatment of PWSs, we studied a group of patients with PWSs using both ELM and histological analysis. Results: A correlation existed between a gray-whitish veil seen by ELM and the vessel depth judged by histology: when the veil was absent, the vessels were always found to be located only in the upper third of the dermis. Conclusion: We think that the gray-whitish veil is a distinctive dermoscopic feature that is able to differentiate between superficial vessels (absence of veil) and deeper vessels (presence of veil).

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The treatment of port-wine stains by the pulsed dye laser. Analysis of pulse duration and long-term therapy

Cited by 106 publications

References 0 publications

Effects of Cryogen Spray Cooling and High Radiant Exposures on Selective Vascular Injury During Laser Irradiation of Human Skin

Effects of Cryogen Spray Cooling and High Radiant Exposures on Selective Vascular Injury During Laser Irradiation of Human Skin

Changes in Skin Redness, Pigmentation, Echostructure, Thickness, and Surface Contour After 1 Pulsed Dye Laser Treatment of Port-wine Stains in Children

Epiluminescence Microscopy for Port-Wine Stains: Pretreatment Evaluation

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