Evaluating the efficacy of treatment of resistant port-wine stains with variable-pulse 595-nm pulsed dye and 532-nm Nd:YAG lasers

BACKGROUND. Some port wine stains (PWSs), despite multiple treatments with the 585-nm 0.45-ms pulsed dye laser (PDL), fail to improve substantially. OBJECTIVE. To determine the efficacy and tolerability of variable pulse width 595-nm PDL and 532-nm Nd:YAG laser in the treatment of resistant PWS. METHODS. Twenty-two patients whose PWS failed to achieve more than 75% lightening after more than 15 treatments with the 585-nm 0.45-ms PDL were recruited. A homogenous patch of PWS was divided into five areas. Area 1 (control area) was treated with 585-nm, 0.45-ms PDL (fluence 7.5 J/cm(2)). Areas 2 and 3 were treated with 595-nm PDL at fluence 15 J/cm(2) (with cryogen spray cooling) and pulse durations of 1.5 and 10 ms, respectively. Areas 4 and 5 were treated with a 532-nm Nd:YAG laser at 2 ms, 7 J/cm(2) and 10 ms, 16 J/cm(2), respectively (with a contact cooling tip). The response was assessed by photographic evaluation. RESULTS. Three patients had further lightening in area 2, and two patients had further lightening in area 3. Each of three patients had further lightening in areas 4 and 5, respectively. One patient had further lightening in the control area. CONCLUSION. In individual patients, it may be effective to treat resistant PWS with the variable-pulse width 595-nm PDL and the 532-nm Nd:YAG laser.