• PDL Treatment of Port-Wine Stains Without General Anesthesia in Infancy

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    JAMA Dermatology
    Published online March 13, 2019

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    Recent concerns about repetitive use of general anesthesia in young children and infants have rekindled the debate on when to start laser treatment for port-wine stains. Jeon et al. reviewed outcomes for patients who began pulsed dye laser (PDL) therapy, without anesthesia, in the first year of life. They found the treatment to be effective as well as safe, with more than two-thirds of the treated children experiencing outcomes that were excellent or better.

    For this study, the authors reviewed medical records of 197 children who received PDL therapy for port-wine stains at ≤1 year of age; treatment occurred between 2000 and 2017. The mean age at initial treatment was 3.38 months (range, 5-355 days), and the mean number of treatments per patient was 9.8 (range, 2-23). Most of the children (n = 149; 76%) had port-wine stains on their faces. Metal corneal shields were used to protect children who had lesions that involved the periocular region.

    The primary outcome was improvement of the vascular birthmarks. Before-and-after images were graded by four physicians according to a five-point vi­sual analog scale (VAS), with 1 = poor (0%-25% improvement) and 5 = complete (100% clearance). All told, 51 of the children (25.9%) had complete clearance, 81 (41.1%) had an excellent outcome, 44 (22.3%) had good results, 13 (6.6%) had fair outcomes, and eight (4.1%) had poor results. The mean VAS score was 3.65 (standard deviation, 1.26), denoting excellent clearance. The presence of a lesion at V1 (the first branch of the trigeminal nerve) correlated significantly with a higher clearance rate. No patient had scarring or a permanent change in pigment.

    Based on the results, the authors support early in-office treatment of in­fants with port-wine stains, particularly if the patient’s risk for complications is minimal. Early intervention with PDL therapy allows for treatment without general anesthesia, maximizing the like­lihood of clearance before school age and, in turn, minimizing the negative consequences of these birthmarks.

    The original article can be found here.