title: Treatment of port-wine stains with a short pulse width 532-nm Nd:YAG laser.
abstract: OBJECTIVE
  Pulsed dye laser treatment often results in port-wine stain (PWS) improvement; however, results vary. A frequency-doubled neodymium-doped yttrium aluminum garnet (Nd:YAG) laser that allows for shorter pulse widths along with large spot sizes and high fluences has been developed for the treatment of cutaneous vascular lesions.
  
  
  METHODS
  A prospective, controlled study was performed in 5 adults with PWS using a frequency-doubled Nd:YAG laser (Excel V; Cutera Inc, Brisbane, CA) in 4 quadrants, using spot sizes of 6 to 10 mm, fluences of 4.8 to 9 J/cm2, and pulse durations of 3 to 6 ms. An adjacent control area was not treated. Each was assessed immediately posttreatment for purpura and edema and at 1 month for PWS color, size, texture, and thickness. Skin biopsies obtained immediately after and at 1 month posttreatment were evaluated.
  
  
  RESULTS
  All treatment quadrants displayed purpura. At 1-month follow-up, all treatment quadrants showed at least 1 grade of color improvement, from a minimum of 1% to 25% to a maximum of 51% to 75% improvement (12/20 quadrants with 1%-25% improvement, 3/20 with 26%-50%, 5/20 with 51%-75%, and 0/20 with 76%-100%). Histologic evaluation of treatment quadrants revealed vascular changes ranging 0.35 to 4 mm in depth. Immediately posttreatment, thrombi and extravasated red blood cells were observed in treatment quadrants. Histology at 1 month revealed decreased number and diameter of vessels in treatment quadrants (superficial vessels decreased by mean 1.1 vessels per section [13%], and diameter by 3.0 μm [47%], midlevel vessels decreased in number by 2.3 [20%], diameter by 2.42 μm [25%], and deep vessels decreased in number by 1.5 [83%], and diameter by 7.44 μm [88%]).
  
  
  CONCLUSIONS
  A single treatment with a short pulse width, frequency-doubled Nd:YAG laser resulted in safe and effective improvement of PWS, with up to 75% improvement in color observed at 1 month. Histologic evaluation demonstrated vascular injury at depths of 0.35 to 4 mm with a reduction in vessel number and size at multiple dermal levels.
authors: Laser & Skin Surgery Center of New York, New York, NY, USA. kavithareddymd@gmail.com
authors: Kavitha K
authors: KK
authors: Reddy
authors: Jeremy A
authors: JA
authors: Brauer
authors: Munir H
authors: MH
authors: Idriss
authors: Robert
authors: R
authors: Anolik
authors: Leonard
authors: L
authors: Bernstein
authors: Lori
authors: L
authors: Brightman
authors: Elizabeth
authors: E
authors: Hale
authors: Julie
authors: J
authors: Karen
authors: Elliot
authors: E
authors: Weiss
authors: Dirk
authors: D
authors: Elston
authors: Roy G
authors: RG
authors: Geronemus
mesh_terms: D000328:Adult; D002196:Capillaries / Q000473:pathology; D003116:Color; D004487:Edema / Q000473:pathology; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019339:Port-Wine Stain / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D011693:Purpura / Q000473:pathology; D012039:Regional Blood Flow; D012867:Skin / Q000098:blood supply / Q000473:pathology; D016896:Treatment Outcome