Treatment of Port-Wine Stain Birthmarks Using the 1.5-msec Pulsed Dye Laser at High Fluences in Conjunction with Cryogen Spray Cooling

Abstract

background. The majority of port-wine stain (PWS) patients treated with the pulsed dye laser (PDL) do not achieve complete blanching. Safe administration of higher fluences has been proposed as a means of improving treatment efficacy. objective. To determine the safety and efficacy of PWS treatment with the 1.5-msec PDL at high fluences in conjunction with cryogen spray cooling. methods. Twenty PWS patients were treated with the PDL in combination with cryogen spray cooling utilizing a 7 or 10 mm spot size and fluences ranging from 6 to 15 J/cm 2 . Before and after treatment photographs were compared on a blinded basis.

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

“…PWSs improved significantly, often dramatically, following treatment with the long pulseduration PDL. Our results agree with Kelly et al [14], who showed similar rates of clearance using the same type of laser and an average of 3.3 treatments per patient. Further increasing the pulse duration may allow treatment of larger vessels still, since evidence suggests that pulsedurations ranging from 0.45-20 milliseconds would be optimal for clearing PWSs [9,15], with the optimal pulseduration probably varying somewhat as a function of PWS vessel depth and diameter.…”

“…We report on the treatment of a large number of previously untreated PWSs. In addition, to having a longer pulse duration than previous generation PDLs, newer PDLs utilize surface cooling that protects the epidermis during treatment, resulting in decreased pain and increased efficacy by enabling the delivery of higher treatment fluences [10][11][12][13][14]. In this study, we further our initial observations of increased efficacy of the 1.5-millisecond pulse-duration PDL utilizing a dynamic cooling device (DCD), for treating PWSs.…”

“…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.…”

Epidermal and vascular damage analysis of in vivo human skin in response to 595 nm pulsed laser irradiation

“…Current clinical studies give valuable information of the outcome of the therapy, [29][30][31][32][33] but lack information on the degree of purpura, histologic analysis, and insight into the mechanism of vascular damage. Additionally, most of these clinical studies limit the fluences used to 10 J/cm 2 .…”

Measurements of laser light attenuation following cryogen spray cooling spurt termination

“…The novel method of achieving selective epidermal protection with ''dynamic'' or cryogen spray cooling (CSC) is well established and in current use for laser treatment of selected dermatoses [1][2][3][4][5][6][7][8]. However, while CSC can protect the epidermis from non-specific thermal damage, the cryogen film that forms on the skin surface may pose a potential problem of laser light attenuation due to optical scattering.…”