Flashlamp-Pumped Pulsed Dye Laser (585nm) for the Treatment of PortwineStains - A Study of Treatment Outcome in 94 Asian Patients in Singapore

CL Goh
Correspondence: C L Goh

ABSTRACT
Background This is a report of a prospective study on the treatment outcome of 94 Asian skin Types III and IV patients with port-wine stains with the 585 nm flashlamp-pumped pulsed dye laser in Singapore.
Patients All patients had completed at least 1 year of follow-up post treatment and had received treatment at 8-12 weekly intervals under topical lodocaine-prilocaine anaesthesia. Our patients received an average of 4 treatments sessions. At the end of each treatment (8-12 weeks after the last laser treatment/before the next laser treatment) and on completion of the last treatment (8-12 weeks after the final laser treatment), patients were assessed for response based on a subjective scoring system where excellent = > 75% improvement, good = 50% to 75% improvement, fair = 25% to 49% improvement and poor = < 25% improvement and the same = no observable improvement. The dermatologist also recorded scores after each treatment in a similar way. On completion of the final treatment, patients were asked to score (8-12 weeks after the final laser treatment) the overall response to the treatment themselves using the same scoring system. The mean age was 26.4 years (range 1 year to 58 years). The mean initial treatment energy density dose was 6.24 J/cm2. Eighty percent of our patients experienced excellent or good response to treatment after the initial treatment and further improvements were observed with each subsequent treatment.
Results The author scored 86% of our patients having "excellent" or "good" response while 83% of our patients scored "excellent" or "good" response upon completion of their treatment. The dermatologist generally recorded better improvement scores than the patients. The dermatologist scored 36% and 50% of our patients having "excellent" and "good" response respectively. The corresponding treatment response scores by our patients were 22% ("excellent") and 61% ("good").
Conclusion Macular lesions appear to respond better than papular/nodular lesions, but the difference was not statistically significant probably due to the small study cohort. Light coloured port-wine stains tended to respond better to treatment than darker lesions (not statistically significant), but overall, all colour lesions responded well to treatment. Patients' expectation of improvements was generally higher than the dermatologist's.

Keywords: capillary malformation, capillary haemangioma, cosmetic laser treatment
Singapore Med J 2000; 41(1): 24-28