Alexandrite Laser for the Treatment of Port Wine Stains Refractory to Pulsed Dye Laser

Abstract

The 755-nm ms pulsed Alexandrite laser (MSPAL) has been reported to be successfully in the treatment of port wine stains (PWS) that are refractory to pulsed dye laser (PDL). This was a prospective pilot study to assess the degree of improvement after a series of treatments with a MSPAL for hypertrophic, nodular, and macular PWS refractory to PDL. Treatment was administered to the PWS using the 755-nm MSPAL at settings of 3-ms pulse duration, 8- to 12-mm spot, 40 to 60 J/cm(2), and dynamic cooling of 60/40. Patients received a series of two to four treatment session, given at 6- to 8-week intervals. The eight patients in this study had undergone a mean of 25.9 treatment sessions with PDL over 8.8 years. The number of MSPAL sessions required for significant improvement of PWS ranged from two to four (mean 2.6). From before treatment to 2 months after treatment, the mean score decreased from 3.2 to 1.4 for skin color (56.3% mean improvement, 95% confidence interval (CI)=53.2-59.4%), from 2.5 to 1.0 at (60.0% mean improvement, 95% CI=55.9-64.1%) for skin texture, and from 3.2 to 1.3 (59.4% mean improvement, 95% CI=56.2-62.6%) for overall cosmetic outcome (all p<.05). In this pilot study, PDL-resistant PWS responded significantly to a series of MSPAL treatments. Given the potential for adverse effects and narrow therapeutic index, treatment with conservative parameters and close observation of tissue response are essential.