A randomized side-by-side study comparing alexandrite laser at different pulse durations for port wine stains

TY - JOUR

T1 - A randomized side-by-side study comparing alexandrite laser at different pulse durations for port wine stains

AU - Carlsen, Berit C

AU - Wenande, Emily

AU - Erlendsson, Andres M

AU - Faurschou, Annesofie

AU - Dierickx, Christine

AU - Haedersdal, Merete

N1 - © 2016 Wiley Periodicals, Inc.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background and Objectives: Pulsed dye laser (PDL) represents the gold-standard treatment for port wine stains (PWS). However, approximately 20% of patients are poor responders and yield unsatisfactory end-results. The Alexandrite (Alex) laser may be a therapeutic alternative for selected PWS subgroups, but optimal laser parameters are not known. The aim of this study was to assess clinical PWS clearance and safety of Alex laser at a range of pulse durations. Materials and Methods: Sixteen individuals (14 previously PDL-treated) with deep red (n = 4), purple macular (n = 5) and purple hypertrophic (n = 7) PWS were included. Four side-by-side test areas were marked within each lesion. Three test areas were randomized to Alex laser at pulse durations of 3, 5, or 10 ms (8 mm spot, DCD 60/40), while the fourth was untreated. The lowest effective fluence to create purpura within the entire test spot was titrated and applied to intervention areas. Standardized clinical photographs were taken prior to, immediately after laser exposure and at 6–8 weeks follow up. Clinical PWS clearance and laser-related side effects were assessed using clinical photos. Results: Alex laser at 3, 5, and 10 ms pulse durations demonstrated significant clearance compared to untreated controls (P < 0.001). Three milli second pulse duration exhibited improved clearance versus 5 ms (P = 0.016) and 10 ms (P = 0.004), while no difference between five and 10 ms was shown (P = 0.063). Though not significant, good responders (>50% clearance) were more likely to have purple hypertrophic PWS (5/7) compared to purple macular (2/5) and deep red lesions (1/4). Eight laser-exposed test areas (17%) developed hypopigmented atrophic scarring. Side effects tended to be more frequently observed with 5 ms (n = 4) and 10 ms (n = 3) versus 3 ms pulse duration (n = 1). Correspondingly, 3 ms was associated with a superior (n = 6) or comparable (n = 10) overall cosmetic appearance for all individuals. Conclusion: Alex laser at 3 ms pulse duration offers superior clinical clearance and safety compared to 5 and 10 ms, and seems best suited for purple hypertrophic PWS. Treatment should be restricted to experienced personnel due to a particularly narrow therapeutic window. Lasers Surg. Med. 49:97–103, 2017.

AB - Background and Objectives: Pulsed dye laser (PDL) represents the gold-standard treatment for port wine stains (PWS). However, approximately 20% of patients are poor responders and yield unsatisfactory end-results. The Alexandrite (Alex) laser may be a therapeutic alternative for selected PWS subgroups, but optimal laser parameters are not known. The aim of this study was to assess clinical PWS clearance and safety of Alex laser at a range of pulse durations. Materials and Methods: Sixteen individuals (14 previously PDL-treated) with deep red (n = 4), purple macular (n = 5) and purple hypertrophic (n = 7) PWS were included. Four side-by-side test areas were marked within each lesion. Three test areas were randomized to Alex laser at pulse durations of 3, 5, or 10 ms (8 mm spot, DCD 60/40), while the fourth was untreated. The lowest effective fluence to create purpura within the entire test spot was titrated and applied to intervention areas. Standardized clinical photographs were taken prior to, immediately after laser exposure and at 6–8 weeks follow up. Clinical PWS clearance and laser-related side effects were assessed using clinical photos. Results: Alex laser at 3, 5, and 10 ms pulse durations demonstrated significant clearance compared to untreated controls (P < 0.001). Three milli second pulse duration exhibited improved clearance versus 5 ms (P = 0.016) and 10 ms (P = 0.004), while no difference between five and 10 ms was shown (P = 0.063). Though not significant, good responders (>50% clearance) were more likely to have purple hypertrophic PWS (5/7) compared to purple macular (2/5) and deep red lesions (1/4). Eight laser-exposed test areas (17%) developed hypopigmented atrophic scarring. Side effects tended to be more frequently observed with 5 ms (n = 4) and 10 ms (n = 3) versus 3 ms pulse duration (n = 1). Correspondingly, 3 ms was associated with a superior (n = 6) or comparable (n = 10) overall cosmetic appearance for all individuals. Conclusion: Alex laser at 3 ms pulse duration offers superior clinical clearance and safety compared to 5 and 10 ms, and seems best suited for purple hypertrophic PWS. Treatment should be restricted to experienced personnel due to a particularly narrow therapeutic window. Lasers Surg. Med. 49:97–103, 2017.

KW - Adolescent

KW - Adult

KW - Aged

KW - Biopsy, Needle

KW - Denmark

KW - Dose-Response Relationship, Radiation

KW - Female

KW - Follow-Up Studies

KW - Hospitals, University

KW - Humans

KW - Immunohistochemistry

KW - Lasers, Dye/therapeutic use

KW - Lasers, Solid-State/therapeutic use

KW - Low-Level Light Therapy/methods

KW - Male

KW - Middle Aged

KW - Port-Wine Stain/pathology

KW - Prospective Studies

KW - Radiation Dosage

KW - Severity of Illness Index

KW - Time Factors

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1002/lsm.22532

DO - 10.1002/lsm.22532

M3 - Journal article

C2 - 27121176

SN - 0196-8092

VL - 49

SP - 97

EP - 103

JO - Lasers in Surgery and Medicine

JF - Lasers in Surgery and Medicine

IS - 1

ER -