Pulsed dye laser (PDL) is widely accepted as the gold standard treatment of port-wine stains (PWS), but there is controversy about when to begin treatment and in what setting it should be done.
According to Roy G. Geronemus, M.D., the answer to the first question is, the sooner the better. Earlier treatment allows for better outcomes and avoids the adverse sequelae that accompany a delay. In addition, his experience supports performing the treatment in the office without the use of anesthesia where it can be done very safely and atraumatically for both the child and the parents.
“Infants born with a PWS should go from out of the hospital into the dermatologist’s office,” said Dr. Geronemus, director, Laser & Skin Surgery Center of New York, and clinical professor of dermatology, New York University Medical Center, New York, NY.
“Parents whose babies have a disfiguring PWS are anxious for options that can eliminate the lesion, and dermatologists who treat PWS need to make the effort to accommodate these families in their appointment schedule. We also need to educate our colleagues in pediatrics about the benefits and safety of early treatment so that they will make the referral.”
ARGUMENTS FOR EARLY INTERVENTION
One of the reasons that favor early initiation of PDL treatment is that it is likely to afford the best outcome.
“Anecdotal evidence shows that the response to PDL is better when the treatment is done in younger versus older children. Earlier treatment results in more complete clearing and requires fewer sessions,” Dr. Geronemus says.
There are several explanations for the better results in younger children. Penetration of the laser energy to its target – the hemoglobin in the PWS capillaries – is better because babies have thinner skin. In addition, the natural history of PWS is that they thicken, darken, and become larger as the child grows, and these features also make clearance more challenging.
Treatment in infancy also enables performance without general anesthesia because it is easier to hold and immobilize a baby than it is an older child.
Dr. Geronemus is an investigator for and on the medical advisory board for Candela