Laser treatment of congenital facial port-wine stains: long-term efficacy and complication in Chinese patients.

Abstract

Pulsed dye laser (585 nm, 450 micros) and variable pulse width frequency doubled Nd:YAG 532 nm laser have been proven to be effective in treating vascular lesions in Caucasians especially in facial port-wine stain. Their roles in dark-skinned Asian have not been determined. The objective of this study was to assess the long-term outcome and complication of laser treatment of congenital facial port-wine stain in Chinese patients retrospectively. Files of all patients with port-wine stains who had received laser treatment in a major regional laser center in a 5-year period were reviewed. Chinese patients with congenital facial port-wine stains were recruited for the study. They were called back for questionnaire assessment of their degree of clearance and clinical examination for treatment complication. Detail demographics, result of questionnaire and clinical examination were entered into a database and statistical analyses were conducted where applicable. One hundred and seven patients with congenital facial port-wine stain were recruited for the study. Thirty-six patients had received PDL treatment, 40 patients had VP532 treatment and 31 patients had been treated by both laser systems. A total of 665 treatment sessions had been performed with an average of 6.1 +/- 2.8 sessions (range 3-12). They had been followed-up from 2 to 5 years with a mean period of 3.4 +/- 1.1 years. Over 60% of patients had more than 25% of clearing and the majority of patients (41.1%) had 25-50% of clearing. Less than one-quarter of patients (23%) experienced a clearing more than 50% and no patient had complete clearing. There was no significant difference in the subjective assessment of clearing between patients that had different forms of laser treatments. No patient had recurrence of pigmentation after treatment. Fourteen percent of patients experienced complications and the majority of them had pigmentary changes. Sex, age, number of treatment session, and type of laser machine used were not related to a higher complication rate using the multiple regression analysis. Chinese patients were less responsive to laser treatment with higher complication rate. In addition, more treatment sessions were required to achieve a maximum clearing. However, most of our patients were satisfied with laser treatment (Patient Satisfaction Score=7.25). Dark-skinned patients should not be excluded from laser therapy provided that treatment expectations and risks are fully discussed.