Pulsed dye laser double-pass treatment of patients with resistant capillary malformations

The pulsed dye laser is an effective and established treatment for port-wine stains and has become the generally accepted standard of care. However, in many cases, complete clearance cannot be achieved as a significant proportion of lesions become resistant to treatment. Multiple passes or pulse-stacking techniques have been used to improve the extent and rate of fading, but concerns over increased adverse effects have limited this clinical approach. In this work, a double-pass technique with the pulsed dye laser has been described, which may allow for increased depth of vascular injury, greater efficacy, and an acceptable risk profile. Our aim was to determine the efficacy and the rate of side-effects for a double-pass protocol with a pulsed dye laser (PDL) to treat patients previously treated with PDL and/or other laser modalities. A retrospective chart review was conducted of 26 patients treated with a minimum of three double-pass treatments alone, or in combination, with single pass conventional PDL. Almost half of the patients (n=12) showed either a moderate or significant improvement in fading compared to pre-treatment photographs with the double-pass technique. In a further 12 patients, there was a mild improvement. In two patients, there was no change. Sixteen patients developed mild side-effects: blisters (n=5), dry scabs (n=11) and transient hyperpigmentation (n=4). This preliminary experience suggests that a double-pass technique at defined intervals between the first and second treatment with PDL can further lighten some port-wine stains, which are resistant to conventional single-pass treatments. This technique may be a useful addition to the laser treatment of PWS and deserves further scrutiny with randomized prospective studies and histological analysis to confirm the increased depth of vascular injury.