Comparing the effectiveness of 585‐nm vs. 595‐nm wavelength pulsed dye laser treatment of port wine stains in conjunction with cryogen spray cooling

Abstract

Background and Objectives: The objective of this study was to compare the efficacy and safety of cryogen spray cooled laser treatment (CSC-LT) at wavelengths of 585 nm vs. 595 nm for port wine stain (PWS) birthmarks in a large series of patients. Study Design/Materials and Methods: A retrospective review was conducted of 64 patients with PWS treated with the ScleroPLUS 1 [Candela (Wayland, MA)] pulsed dye laser (l ¼ 585 or 595 nm wavelength; spot size 7 mm, t p ¼ 1,500 microseconds) over a 3-year period. Subjects' ages ranged between 3 months and 64 years; there were 42 females and 22 males, all of whom were Asian. Number of treatments ranged from 1 to 6. Duration of treatment ranged from 6 months to 2 years 11 months, with a mean of 12 months. Patients (n ¼ 32) received CSC-LT (585 nm) using radiant exposures of 7-10 J/cm 2 . A second group of patients (n ¼ 32) received CSC-LT (595 nm) using radiant exposures of 7-10 J/cm 2 . The primary efficacy measurement was the quantitative assessment of blanching response scores for CSC-LT (585 nm) versus CSC-LT (595 nm). Patients were monitored for adverse effects. Results: Based on chi-squared analysis, there were clinical, and statistically significant, differences in blanching response scores favoring PWS receiving CSC-LT (585 nm) as compared to CSC-LT (595 nm) (P < .001). Transient hyperpigmentation was noted in 43.7% (n ¼ 14) and 37.5% (n ¼ 12) of patients in the CSC-LT (585 nm) and CSC-LT (595 nm) groups, respectively. In both groups, transient hyperpigmentation resolved in all patients within 1 year. Permanent hypopigmentation or scarring was not observed in either group. Conclusions: CSC-LT (585 nm) resulted in superior blanching as compared to CSC-LT (595 nm). Further study is required to optimize wavelength selection on an individual patient basis during PWS therapy in order to improve treatment results.

Efficacy of the 1.5 millisecond pulse‐duration, 585 nm, pulsed‐dye laser for treating port‐wine stains

“…The absorption coefficient of blood is a factor of 5 higher at 585 nm than 595 nm [20]. In addition, mathematical modeling suggests that 585 nm may be an optimal wavelength for treating PWSs [20][21][22][23][24]. Chang et al [20] compared the effectiveness of the 1.5-millisecond pulse-duration PDL used in our current study at two different wavelengths, 585 and 595 nm.…”

“…Melanin pigment in the epidermis is a competing absorber across the wavelengths typically used to treat PWSs. The addition of surface cooling, to preferentially protect the epidermis while allowing heat to accumulate in PWS vessels, has been a major advance in the treatment of PWSs [10][11][12][13][14]20]. The DCD applies a cryogen spurt to the skin surface immediately prior to delivery of the laser pulse.…”

“…The cryogen preferentially cools the surface of the skin, protecting the epidermis from laser injury. This device will allow delivery of higher fluences, while minimizing side effects [20]. Varying the timing and duration of the cryogen spurt, as well as possibly incorporating multiple spurts per laser pulse, may further improve the benefits of this novelcooling device.…”

Prospective study of port wine stain treatment with dye laser: Comparison of two wavelengths (585 nm vs. 595 nm) and two pulse durations (0.5 milliseconds vs. 20 milliseconds)

“…In the meantime, pulsed-dye lasers are available at wavelengths of 585-600 nm, pulse durations of up to 40 milliseconds and much higher fluences. A clinical assessment of these new devices has yet to keep up with their increasingly widespread use, however, and there are only few studies on the topic [13][14][15][16][17]. Edström and Ros focused on a comparison of 585 and 600 nm; Chang et al assessed the wavelengths 585 and 595 nm with a pulse duration of 1.5 milliseconds each in conjunction with cryogen-spray cooling in their retrospective study.…”

Real-time photothermal imaging and response in pulsed dye laser treatment for port wine stain patients

“…[17] Because the time period of laser illumination can be abrupt, these target tissues exhibit photothermal phenomena by absorbing the high energy of a laser beam nearly instantaneously, where the surrounding tissue is narrowly affected. Therefore, the energy is capable of damaging the target tissues and not injuring the surrounding skin, a concept closely related to the knowledge of heat transfer.…”