title: Treatment of recalcitrant port-wine stains (PWS) using a combined pulsed dye laser (PDL) and radiofrequency (RF) energy device.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Small sample size and short follow-up period are limitations.
  
  
  CONCLUSIONS
  Combined RF/PDL technology is promising for the treatment of recalcitrant PWS.
authors.affiliation: Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York; Laser and Skin Surgery Center of New York, New York, New York. Electronic address: yoonsoobae@yahoo.com.
authors.forename: Yoon-Soo Cindy
authors.initials: YC
authors.lastname: Bae
authors.affiliation: Laser and Skin Surgery Center of New York, New York, New York.
authors.forename: Hamad
authors.initials: H
authors.lastname: Alabdulrazzaq
authors.affiliation: Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York; Laser and Skin Surgery Center of New York, New York, New York.
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Brauer
authors.affiliation: Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York; Laser and Skin Surgery Center of New York, New York, New York.
authors.forename: Roy G
authors.initials: RG
authors.lastname: Geronemus
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004598:Electrosurgery / Q000295:instrumentation; D005260:Female; D006801:Humans; D054025:Lasers, Dye / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019339:Port-Wine Stain / Q000601:surgery*; D011446:Prospective Studies
keywords: cutaneous laser; pulsed dye laser; radiofrequency; recalcitrant port-wine stains