Correspondence

Redarkening of Port-Wine Stains 10 Years after Laser Treatment

N Engl J Med 2007; 356:2745-2746June 28, 2007

Article

To the Editor:

Huikeshoven et al. (March 22 issue)1 report redarkening of port-wine stains after pulsed-dye–laser therapy. The device and fixed variables used in this study were not optimal, thus minimizing the therapeutic outcome and most likely increasing the recurrence of port-wine stains by permitting many vessels to remain unaffected by treatment.

Advances in pulsed-dye–laser technology through the use of larger spot sizes, higher energy densities, varying pulse widths, and dynamic cooling allow for more effective treatment of port-wine stains through greater vessel heating and deeper vascular injury.2 The improved technology targets the heterogeneity in blood-vessel sizes that is characteristic of port-wine stains.3

Any study evaluating the response of port-wine stains to treatment should include an analysis based on the location of the anatomical malformation and the patient's age. As compared with other areas of the face and neck, port-wine stains on the center of the face have been shown to respond less effectively to treatment and are more likely to recur.4 An aggressive approach to treating infants and young children can also allow for more rapid and complete clearing.5

J. Stuart Nelson, M.D., Ph.D.
Beckman Laser Institute, Irvine, CA 92612
jsnelson@uci.edu

Roy G. Geronemus, M.D.
New York University Medical Center, New York, NY 10016

5 References

1. 1

   Huikeshoven M, Koster PHL, de Borgie CAJM, Beek JF, van Gemert MJC, van der Horst CMAM. Redarkening of port-wine stains 10 years after pulsed-dye-laser treatment. N Engl J Med 2007;356:1235-1240
   Full Text | Web of Science | Medline

2. 2

   Nelson JS, Milner TE, Anvari B, Tanenbaum BS, et al. Dynamic epidermal cooling during pulsed laser treatment of port wine stain: a new methodology with preliminary clinical evaluation. Arch Dermatol 1995;131:695-700
   CrossRef | Web of Science | Medline

3. 3

   Barsky SH, Rosen S, Geer DE, Noe JM. The nature and evolution of port wine stains: a computer-assisted study. J Invest Dermatol 1980;74:154-157
   CrossRef | Web of Science | Medline

4. 4

   Renfro L, Geronemus RG. Anatomical differences of port-wine stains in response to treatment with the pulsed dye laser. Arch Dermatol 1993;129:182-188
   CrossRef | Web of Science | Medline

5. 5

   Geronemus RG, Quintana AT, Lou WW, Kauvar A. High-fluence modified pulsed dye laser photocoagulation with dynamic cooling of port-wine stains in infancy. Arch Dermatol 2000;136:942-943
   CrossRef | Web of Science | Medline

Author/Editor Response

With ongoing research in medicine, investigating the 10-year follow-up results of any medical treatment inevitably leads to somewhat outdated results at the time of presentation. This is especially the case in a field that is subject to continuous development, such as pulsed-dye–laser treatment of port-wine stains. As Nelson and Geronemus point out, the results with newer pulsed-dye lasers have been reported to be promising and superior to the results with the laser used in our study. However, to date no controlled comparative studies have shown improved clinical efficacy. Whether the new lasers have improved long-term efficacy remains to be reported; in light of our observation of the recurrence of port-wine stains, we certainly hope they do.

No differences or trends in responses to treatment related to the anatomical locations of the port-wine stains were observed in either the original study1,2 or the current follow-up study, possibly because of the relatively small number of patients. Furthermore, in the original study, age was shown to have no influence on the response to treatment. Therefore, we refrained from performing age-dependent analyses in the current long-term follow-up assessment.

Menno Huikeshoven, M.D., Ph.D.
Chantal M.A.M. van der Horst, M.D., Ph.D.
Academic Medical Center, 1100 DE Amsterdam, the Netherlands
m.huikeshoven@amc.uva.nl

2 References

1. 1

   van der Horst CMAM, Koster PHL, de Borgie CAJM, Bossuyt PMM, van Gemert MJC. Effect of the timing of treatment of port-wine stains with the flash-lamp-pumped pulsed-dye laser. N Engl J Med 1998;338:1028-1033
   Full Text | Web of Science | Medline

2. 2

   Kauvar AN, Geronemus RG. Treatment of port-wine stains. N Engl J Med 1998;339:635-636
   Full Text | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   Yu-Chih Huang, Nadia Tran, Peter R. Shumaker, Kristen Kelly, E. Victor Ross, J. Stuart Nelson, Bernard Choi. (2009) Blood flow dynamics after laser therapy of port wine stain birthmarks. Lasers in Surgery and Medicine 41:8, 563-571
   CrossRef

2. 2

   N. Dupin. (2007) Quoi de neuf en dermatologie clinique ?. Annales de Dermatologie et de Vénéréologie 134, 8S3-8S15
   CrossRef