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Original Investigation
March 13, 2019

Pulsed Dye Laser Treatment of Port-Wine Stains in Infancy Without the Need for General Anesthesia

Author Affiliations
  • 1Laser & Skin Surgery Center of New York, New York
  • 2Department of Dermatology, Weill Cornell Medical Center, New York, New York
  • 3Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
JAMA Dermatol. 2019;155(4):435-441. doi:10.1001/jamadermatol.2018.5249
Key Points

Question  Is it safe and effective to initiate port-wine stain laser treatments without general anesthesia in infancy?

Findings  In this retrospective analysis of 197 infants with port-wine stains who began laser treatment during infancy, 25.9% of the patients achieved 100% clearance and 41.1% showed 76% to 99% improvement. On average, patients appeared to achieve excellent clearance, and none of the patients experienced scarring or permanent pigmentary change.

Meaning  The findings of this study suggest that treatment of port-wine stains in infancy is both safe and effective, allowing for treatment without general anesthesia and successful therapeutic outcome.

Abstract

Importance  Recent concerns regarding repetitive use of general anesthesia in children younger than 3 years have placed greater importance on the controversy surrounding the timing of the initiation of port-wine stain (PWS) laser treatment.

Objective  To evaluate the use of PWS treatments at the age of 1 year or younger in the office setting without general anesthesia.

Design, Setting, and Participants  Retrospective cohort study based on medical record reviews at a single, high-volume laser center for children who started pulsed dye laser treatment at the age of 1 year or younger for their PWS between 2000 and 2017. The data cutoff was at 1 year after the initial treatment to have comparable data points.

Main Outcomes and Measures  The primary outcome was improvement of PWSs using before and after photographs, which were reviewed by 4 physicians independently and graded using the following 5-point visual analog scale (VAS): poor (grade 1: 0%-25% improvement), fair (grade 2: 26%-50% improvement), good (grade 3: 51%-75% improvement), excellent (grade 4: 76%-99% improvement), and complete (grade 5: 100% improvement) clearance.

Results  Of the 197 patients (73 [37.1%] boys; 124 [62.9%] girls), most (149 [75.6%]) had facial lesions. The mean age at the time of first treatment was 3.38 months (range, 5-355 days) and the mean number of treatments was 9.8 (range, 2-23; median, 10). Per the mean physician VAS grading of 197 patients, 51 patients (25.9%) showed 100% clearance (mean [range] VAS score of 4.78 [4.5 – 5]); 81 patients (41.1%) showed 76 to 99% improvement (mean [range] VAS score of 3.91 [3.5 to <4.5]); 44 patients (22.3%) showed 51% to 75% improvement (mean [range] VAS score of 2.86 [2.5 to <3.5]); 13 patients (6.6%) showed 26% to 50% improvement (mean [range] VAS score of 2.12 [1.5 to <2.5]); and 8 patients (4.1%) showed 0 to 25% improvement (mean [range] VAS score of 0.78 [0 to <1.5]). The presence of a V1 (first branch of the trigeminal nerve [ophthalmic nerve]) lesion was associated with a statistically significantly higher clearance rate by a VAS grade of 0.55 (95% CI, 0.25-0.84; P < .001). The mean (SD) VAS grade for all patients was 3.65 (1.26), corresponding to excellent clearance. None of the patients experienced scarring or permanent pigmentary change.

Conclusions and Relevance  In this study, treatment of PWSs in infancy was both safe and effective. Early intervention allows for treatment without general anesthesia, maximizing the chance to achieve clearance before school age and thereby minimizing the negative outcome of PWSs for both the patient and the family.

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