Treatment of recalcitrant port-wine stains (PWS) using a combined pulsed dye laser (PDL) and radiofrequency (RF) energy device

Background: Pulsed dye laser (PDL) is the treatment of choice for port-wine stains (PWS). Some PWS are recalcitrant to this modality. A number of reasons for PDL treatment resistance have been described, including inadequate heat generation. Objective: We evaluated PDL combined with radiofrequency (RF) energy into a single device to target larger and deeper blood vessels and overcome PDL resistance. Method: This was an open-label, prospective, single-center investigation of a novel device combining RF energy with PDL conducted to treat recalcitrant PWS. Ten patients with 11 recalcitrant PWS were enrolled. Each PWS was divided into 5 treatment areas: PDL alone, RF alone, PDL+RF, RF+PDL, and untreated control. Patients underwent a maximum of 6 treatments, scheduled 4 to 6 weeks apart with follow-up evaluation at 4 and 12 weeks after the final treatment. Colorimetry and standardized digital photography were performed at all visits. Lesional biopsy specimens were collected for selected patients. Results: Areas treated with RF followed by PDL and PDL followed by RF showed the greatest improvement based on blinded review of digital photographs, reaching statistical significance (P value <. 05) at the 12-week follow-up evaluation when compared with baseline. Adverse events, including purpura, erythema, edema, scabbing, crusting, and blistering, resolved without sequelae; a small residual scar was noted in 1 patient. Limitations: Small sample size and short follow-up period are limitations. Conclusion: Combined RF/PDL technology is promising for the treatment of recalcitrant PWS.