Abstract
Port-wine birthmarks (PWBs) are progressive vascular malformations with significant disfigurement and psychosocial morbidity; early light-based treatment has shown improved outcomes in the pediatric population. Somatic mosaic mutations underly the progressive nature of PWBs and explain the significant differences in response and heterogeneity of vessel architecture in the pediatric population when compared to the adult cohort. Here, we summarize a review of pediatric specific literature on the various light-based treatment modalities, including pulsed dye laser, near-infrared lasers, and intense pulsed light, providing the various indications, tips, advantages, and disadvantages for the pediatric dermatologist.
Highlights
Port-wine birthmarks (PWBs), often referred to as port-wine stains or capillary malformations, are progressive malformations composed of capillaries and post-capillary venules
PWBs are known to be caused by somatic mosaic mutations in genes that control cell-cycle regulation, including GNAQ, GNA11, PiK3CA, and others that are implicated in cell-cycle signaling.[4]
We review principles of light-based treatment for pediatric port-wine birthmarks
Summary
Port-wine birthmarks (PWBs), often referred to as port-wine stains or capillary malformations, are progressive malformations composed of capillaries and post-capillary venules. Vascular-selective laser wavelengths are absorbed by hemoglobin, converted to heat, resulting in photocoagulation, with injury and necrosis of the endothelial cells These laser-tissue interactions lead to clearance of PWBs. Cooling modalities allow for the use of higher fluences to maximize thermal damage to the target chromophore while minimizing injury to normal skin, enhancing efficacy of light-based treatments by selectively cooling the epidermis.[11] The most common cooling strategies are contact cooling, cryogen spray, or forced air. Infant skin is approximately 40%-60% thinner than adult skin, with relatively less melanin and fewer hair follicles relative to adults.[16] These properties, along with other hypothesized mechanisms including elevated hemoglobin F in infants and smaller vessel size, make pulsed dye laser the treatment of choice in young children with PWB It is the safest laser modality for treatment in the pediatric population. The pulsed dye laser (PDL) was the first laser developed for the treatment of vascular lesions and is the gold standard for TA B L E 1 Light-based therapeutic options for PWB in the pediatric population
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