The multilayer technique: A new and fast approach for flashlamp-pumped pulsed (FLPP) dye laser treatment of port-wine stains (preliminary reports)

BACKGROUND. The 585 nm flashlamp-pumped pulsed (FLPP) dye laser is an effective and established treatment for: port-wine stains (PWSs) during childhood. Unfortunately, PWSs tend to darken in color and may thicken or develop nodules as the lesions age, thereby making treatment difficult in adult patients since they may require several laser sessions producing unpredictable results. The aim of this article is to present and discuss the results obtained in four adult patients with PWS by use of a new approach in FLPP dye laser treatment. OBJECTIVE. The goal of this technique was to damage, during the same treatment, the lesions at both deep and superficial levels and to reduce the number of laser sessions required to obtain the most effective eradication of hypertrophied PWSs. METHODS. Four patients (two men and two women aged 54, 57, 49, and 61, respectively) were referred for treatment of congenital hypertrophied PWS of the face. Every dye laser session consisted of two laser passes. During the first pass the wave-length ranged from 590 to 600 nm with a long pulse (1.500 mu sec), while the second pass was performed utilizing the classic short pulse (450 mu sec) and wavelength (585 nm). Successive treatments were performed at 6- to 8-week intervals. RESULTS. All four patients had a complete clearing of their PWS after a number of treatments, ranging from three to five sessions. Three of them (one man and the two women) experienced extremely mild blistering in a limited small area that healed in approximately 10 days without scarring. The laser sessions were well tolerated by all patients. None of the patients developed atrophic or hypertrophied scars or dyschromia. CONCLUSIONS. Our results show an excellent response in all patients with just a few treatments (three to five sessions) and, in spite of two passes, only mild side effects that are probably limited due to cooling of the skin. We also observed a flattening and reduction of the nodules.