Lasers were first used to treat skin problems in 1963 by Dr Leon Goldman. The first skin lasers were plagued by serious side-effects like scarring and pigmentation problems. However, we’ve come a long way since the 60s! Today, lasers are the treatment of choice for blood vessel birthmarks, especially port wine stains (PWS). In this article, we will cover what you need to know about how skin lasers work, what kind of results you can expect to get when you treat your baby’s PWS with laser, and possible side effects and complications. Treating a cosmetically sensitive area like your baby’s face can be a nerve-wracking experience, so this article hopes to demystify it as much as possible!
Port Wine Stains
Nevus flammeus, most commonly known as port-wine stains, is a birthmark caused by deformed blood vessels that occurs in about 1 in 30 newborns. These are usually slightly raised marks that range from dark red to purple, and are present during the first days of life. Unfortunately, they do not go away with time and may darken or become more raised. Port-wine stains involving the eye and the forehead are sometimes associated with glaucoma (increased pressure that can lead to blindness) and can be associated with a genetic condition called Sturge-Weber syndrome. While only about five percent of babies born with a port wine stain on their forehead have Sturge-Weber, it is very important that all of them are evaluated by a dermatologist given the high risk of glaucoma, seizures, and mental retardation.
Does my baby require treatment?
PWSs can cause significant psychologic and social development problems, so medical treatment is often necessary. Babies younger than one year seem to have more effective lightening and require fewer treatment sessions compared to older ones, so most dermatologists recommend treating as soon as possible to decrease the psychological effects and avoid increasing thickness and size with age. However, other research shows that good PWS lightening after laser treatment can occur in all age groups. For example, a 1998 study of 19 patients treated with laser found no significant difference in lightening between age groups. So, it’s never too late to start! Unfortunately, PWSs can recur years after treatment, even with a really good initial response. That being said, recurrent PWS are usually much smaller and less thick then the original one.
Treatment of Port Wine Stains with Pulsed Dye Laser
Lasers deliver energy extremely precisely into a target while minimizing damage to surrounding structures. Currently, the Pulsed Dye Laser (PDL) is the most effective laser for PWS and other blood-vessel birthmarks. Treated skin will become dark purple, but not gray, which can be a sign of over-treatment. Studies show that one month after treatment, destroyed abnormal blood vessels are substituted by normal-looking vessels without any signs of of scarring!
What kind of results can you expect? Well, one study of 73 children between the ages of 3 months and 14 years found that after an average of 2.5 treatments, almost 90% of patients had lightening of 50% or more. Impressively, lesions lightened an average of 53% after just one treatment!
When treating PWSs, the dermatologist may try to target the smaller more superficial vessels first and the larger, deeper ones last, because they are usually more difficult to treat. Sometimes PWS don’t have an even response to laser treatment due to lots of different sized vessels. Additionally, different blood flow rates through the vessels may also affect the effectiveness. PWS edges, which usually respond best, should be treated first, to avoid accidentally treating uninvolved skin. It is also important for darker-skinned children to wait for as long as 3 to 6 months between sessions to allow post-treatment darkening to resolve.
One of the greatest benefits of using the PDL is the ability to treat small children effectively with very little risk of scarring or permanent pigmentation problems. The reason that children have a better response to PDL treatment than adults is because they have thinner skin and the abnormal blood vessels are smaller and more superficial. However, no laser treatment is risk free. There is about a 1% risk of of scarring when treating pediatric PWSs. Sometimes there is thinning of the skin immediately after treatment, but it generally resolves within a year after stopping treatment. Certain areas of the body respond better than others. For example, the head and neck respond much better than the trunk and legs. Darker-skinned patients can have pigment changes after treatment so it is often better to treat less aggressively and go more slowly. The best results require multiple treatments. It is very rare for a PWS to clear after just one or two treatments. Most require at least four to six treatments, usually spaced out monthly.
A disfiguring birthmark like a PWS can be a nightmare for you who just wants your baby to grow up and live a normal life. You will love them unconditionally, but you know the world can be a cruel place to people who look different. Hopefully, you found this overview helpful. Leave a comment if you have any personal experience with PWS and share this article with other parents who may be interested!