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Special Topics
September 2005

Description and Analysis of Treatments for Port-wine Stain Birthmarks

Author Affiliations

Author Affiliations: Beckman Laser Institute, Irvine (Drs Kelly, Choi, Jung, Khan, Ramirez-San-Juan, and Nelson), and Departments of Dermatology (Drs Kelly, McFarlane, and Nelson), Pediatrics (Dr Motosue), and Biomedical Engineering (Dr Nelson), University of California–Irvine; Department of Biomedical Engineering, Yonsei University, Seoul, South Korea (Dr Jung); and Department of Optics, Instituto Nacional de Astrofisica, Optica y Electronica, Puebla, Mexico (Dr Ramirez-San-Juan).

Correspondence: Kristen M. Kelly, MD, Beckman Laser Institute, 1002 Health Sciences Rd E, Irvine, CA 92612 (KMKelly@uci.edu).

Arch Facial Plast Surg. 2005;7(5):287-294. doi:10.1001/archfaci.7.5.287

Port-wine stain (PWS) birthmarks are congenital, low-flow vascular malformations of the skin. Lasers are the modality of choice for the treatment of PWS birthmarks, and for most patients the pulsed-dye laser in conjunction with epidermal cooling offers the greatest efficacy and safety. Other light devices, including the 532-nm frequency-doubled Nd:YAG laser, intense pulsed light, 1064-nm Nd:YAG laser, and combined 1064/532-nm system, may be useful during a treatment course for resistant PWS. Laser treatment results in blanching of most lesions, although complete resolution may not occur and some resistant PWS birthmarks respond minimally, if at all. Factors limiting laser treatment include variable vascular geometry, inadequate damage of some vessels, and lesional posttreatment recurrence as a result of neovascularization. Alternative or adjunct treatment options that address these limitations should be explored, including noninvasive real-time imaging to optimize the selection of treatment settings, photodynamic therapy, and perioperative use of antiangiogenic compounds.