Does dye laser treatment with higher fluences in combination with cold air cooling improve the results of port-wine stains?
OBJECTIVE
The use of cold air cooling (CAC) and cryogen spray cooling during dye laser treatment of port-wine stains (PWS) has become a standard in recent years. Still unsolved is the question of which fluences are necessary in combination with CAC in order to achieve an optimum clearance and the lowest possible rate of side-effects.


METHODS
In a prospective study, we treated 11 patients with PWS with pulsed dye laser (Photogenica V, Cynosure, lambda = 585 nm, iota(p) = 0.5 ms, spot size = 7 mm). Each PWS was partitioned into three areas: (area 1) 6 J/cm(2) without CAC, (area 2) 6 J/cm(2) with CAC (level 4), (area 3) 9 J/cm(2) with CAC (level 4).


RESULTS
Area 3 (mean, 59%) showed a slightly better clearance than area 1 (mean, 57%); in area 2, we observed a reduced clearance (mean, 45%). Compared with area 1, we achieved a reduction of pain through CAC in areas 2 and 3. The healing periods as well as the rate of side-effects were comparable in all areas.


CONCLUSIONS
We observed a slight but not statistically relevant increase in clearance with the use of higher fluences and CAC compared with lower fluences without CAC. Because pain is lowered significantly when using CAC, and because this makes the treatment more comfortable for the patients, we tend to recommend the use of higher fluences (9 J/cm(2)) with simultaneous CAC for treating PWS.
Hammes
S
S
Laserklinik Karlsruhe, Karlsruhe, Germany.
Roos
S
S
Raulin
C
C
Ockenfels
H-M
HM
Greve
B
B
D000293:Adolescent; D000328:Adult; D000388:Air; D002648:Child; D002675:Child, Preschool; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D054025:Lasers, Dye / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019339:Port-Wine Stain / Q000532:radiotherapy*; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D012881:Skin Temperature; D018709:Statistics, Nonparametric; D016896:Treatment Outcome