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

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[sup 2] . Before and after treatment photographs were compared on a blinded basis. Results: No scarring or skin textural changes occurred. Blanching scores were as follows: 20% of patients achieved 75% or greater blanching after an average of 3.3 treatments, 30% achieved 50–74% blanching, 20% achieved 25–49% blanching, and 30% achieved less than 25% blanching. Conclusion: In conjunction with cryogen spray cooling, the PDL can be safely used at high fluences. At this time it is not clear that the use of higher fluences improves treatment efficacy; however, as other aspects of PWS laser treatment are optimized, safe administration of higher fluences is likely to be advantageous. [ABSTRACT FROM AUTHOR]