Changes in skin redness, pigmentation, echostructure, thickness, and surface contour after 1 pulsed dye laser treatment of port-wine stains in children

Background: The pulsed dye laser is the treatment of choice for children with port-wine stains (PWSs). Evaluation of treatment outcome and adverse effects is traditionally based on subjective clinical scoring systems. We intend to objectify treatment results and adverse reactions after 1 treatment with the pulsed dye laser. Design: A before-and-after trial using skin reflectance to detect changes in skin redness and pigmentation, ultrasonography to evaluate changes in echostructure and skin thickness, and 3-dimensional surface contour analysis to detect changes in surface texture. Patients: Twelve children with PWSs. Setting: A university dermatological department. Results: The skin reflectance-determined change in skin redness correlated with the clinical response (r=0.46, P<.002). The percentage of reflectance-determined lightening was equal for pink, red, and dark red PWSs (median, 42.9%). Skin pigmentation increased after laser treatment (P<.007). Ultrasonography revealed lower dermal echogenicity of preoperative PWSs than of postoperative PWSs (P<.007) and healthy skin (P<.001). An increase in echogenicity reflected a decrease in the dermal water (blood) content. Variations were found in the dermal localization of the PWS. Skin thickness was significantly higher in the PWS before treatment than after (P<.001). The preoperative lesional thickness correlated inversely with the ultrasound-assessed treatment response (r=0.35, P<.04). The surface contour parameters decreased significantly after laser treatment, indicating a flattening of the skin surface. The contour changes correlated positively with treatment response. By clinical evaluation, no hypopigmentation or texture changes were detected. Conclusion: The evaluation of treatment outcome and adverse effects is refined by the use of skin reflectance, ultrasonographic, and surface contour analysis.