At What Age Should Port Wine Stains be Treated?
August 1, 1998
At What Age Should Port Wine Stains be Treated?
ABSTRACT & COMMENTARY
Synopsis: There is no evidence that treatment of port wine stain birthmarks with flashlamp pulsed-dye lasers in early childhood is more effective than treatment at a later age.
Source: Chantal MAM, et al. Effect of timing of treatment of port wine stains with the flash-lamp pulsed-dye laser. N Engl J Med 1998;338:1028-1033.
Port wine stains are congenital vascular lesions that occur in an estimated three children per 1000 births. When on the face, these birthmarks are disfiguring and may cause psychological problems for the child. The modern treatment of port wine stains involves the use of flashlamp-pumped pulsed-dye laser technique in which thermal injury is confined to the dye targeted port wine stain.1 This treatment was hypothesized to be more effective in children than adults because the skin in children is thinner and the size of the port wine stain is smaller so that fewer treatments would be necessary for optimal clearance. Eighty-nine patients were divided into four age groups (0-5 years, 6-11 years, 12-17 years, 18-31 years). The sizes, locations, and colors of port-wine stains were similar among the groups. When all 89 patients were analyzed together, the average reduction in color between the skin with the port wine stain and contralateral healthy skin was 40%. The between age groups in the average reduction in color differences were not significant. There is no evidence that age effects response to therapy.
COMMENT BY MOISE L. LEVY, MD
The treatment of port-wine stains (capillary malformations) with laser has been safely and effectively accomplished for many years with the flashlamp-pumped pulsed-dye laser. Few groups have accumulated large enough numbers of patients to be able to adequately document their experiences. A prospective study published by Chantal and associates from Holland addresses the important issue of timing of treatment with regard to ultimate results of such treatment. Chantal et al, as well as others treating children and adults with port-wine stains with such lasers, has had the "impression" that younger patients require fewer treatments to active maximum clearing of these lesions. While the location of a given lesion and its size are additional variables affecting the ultimate outcome of such treatment, the conclusions of this article are important.
Eighty-nine patients ranging in age from 0-31 years with untreated head/neck port-wine stains were studied. All patients were treated with the same type of pulsed-dye laser using similar parameters. Patients were assessed after an average of five treatments by color measurements (using a reflectance photometer) and photography at least eight weeks after completion of the treatments. Baseline measurements were obtained in the same manner.
Chantal et al found an average improvement of 40% in the color of the port-wine stains after an average of five treatments. This finding was uniform throughout all age categories. A minority (7) of the 89 valuable patients completed therapy during the study period highlighting the possibility that further treatments may have resulted in more clearing. Such results are not as encouraging regarding outcome of treatment as those published by Orten et al in other works.1
While variables, such as location of lesions and their size as mentioned previously in addition to the importance of the depth of vessels within such lesions, refinement of specific laser parameters, and other issues will ultimately affect the results of this important and clinically indicated therapy. Parents may be reassured that such therapy may not need to be started during infancy in order to ensure optimum results. Further examination of such data is certainly warranted.
Reference
1. Orten SS, et al. Arch Otolaryngol Head Neck Surg 1996;112:1174-1179.
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