Port wine stain removal skin#
The blood in neonates also contains a greater proportion of erythrocytes, and young infants have relatively less melanin in the skin that can be a competing chromophore for absorbing the laser energy. Because skin thickness increases with age, penetration of the laser energy to its target- the hemoglobin in the PWS capillaries-is better in younger children. Several factors may explain the better results that are achieved with earlier PDL treatment for PWS. Importantly, available evidence indicates that earlier treatment allows for optimal outcomes, including a greater response and lower risk of recurrence. Early initiation of PDL treatment has several benefits.
Optimal treatment of PWS with the PDL laser involves multiple sessions that are performed until there is no further improvement. Risk of collateral damage to surrounding cutaneous structures is limited by selection of a proper pulse duration that confines thermal injury to the targeted PWS vasculature. Heat that is produced upon hemoglobin absorption of the laser energy results in photocoagulation and aggregation of red blood cells and subsequently necrosis of the vascular endothelial cells. The 595-nm wavelength of the PDL targets hemoglobin in the affected cutaneous blood vessels. The safety and efficacy of PDL treatment of PWS is explained by the principle of selective photothermolysis. With early initiation of treatment in infants, the procedure can be done as an atraumatic in-office treatment without general anesthesia. Performed with proper parameters and with repeated sessions until a plateau in response is reached, the procedure has excellent safety and the potential to provide complete to near-complete clearance.
The vascular-selective pulsed dye laser (PDL) represents the gold standard treatment of PWS. Pediatricians can help these families by referring them to a dermatologist who has expertise treating PWSs in infants. When a baby is born with a disfiguring PWS, parents may be anxious for options to eliminate the lesion. 4,5 Although spontaneous lightening of PWSs has been reported, the typical natural history of these lesions is characterized by an increase in surface area proportional with growth of the child along with darkening and thickening with the potential for spontaneous bleeding. Published studies document the negative emotional and quality-of-life consequences that a PWS has on affected children and how these problems are lessened by treatment that improves the appearance of the lesion. Other than Sturge-Weber syndrome, which is very rare, the most significant concern for children with a PWS is the potential that they will experience stigmatization and psychosocial morbidity because of the disfiguring birthmark. A facial PWS involving the distribution of the V1 (ophthalmic) branch of the trigeminal nerve, however, is a hallmark feature of Sturge-Weber syndrome, and babies with this presentation should be referred to an ophthalmologist and neurologist to screen for glaucoma and brain involvement. 2 The vast majority of PWSs are isolated findings.
These patches vary in size and can occur anywhere on the body, but approximately 80% of PWS lesions are present on the face and neck. 1 These birthmarks, which represent dilated capillaries and postcapillary venules in the dermis, appear as pink or erythematous flat patches that reflect the increased hemoglobin content in the skin. Port-wine stains (PWSs) are a type of congenital vascular malformation estimated to occur in 0.3% to 0.5% of newborns.
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