Background: Some port wine stains (PWSs), despite multiple treatments with the 585-nm 0.45-ms pulsed dye laser (PDL), fail to improve substantially.
Objective: To determine the efficacy and tolerability of variable pulse width 595-nm PDL and 532-nm Nd:YAG laser in the treatment of resistant PWS.
Methods: Twenty-two patients whose PWS failed to achieve more than 75% lightening after more than 15 treatments with the 585-nm 0.45-ms PDL were recruited. A homogenous patch of PWS was divided into five areas. Area 1 (control area) was treated with 585-nm, 0.45-ms PDL (fluence 7.5 J/cm2). Areas 2 and 3 were treated with 595-nm PDL at fluence 15 J/cm2 (with cryogen spray cooling) and pulse durations of 1.5 and 10 ms, respectively. Areas 4 and 5 were treated with a 532-nm Nd:YAG laser at 2 ms, 7 J/cm2 and 10 ms, 16 J/cm2, respectively (with a contact cooling tip). The response was assessed by photographic evaluation.
Results: Three patients had further lightening in area 2, and two patients had further lightening in area 3. Each of three patients had further lightening in areas 4 and 5, respectively. One patient had further lightening in the control area.
Conclusion: In individual patients, it may be effective to treat resistant PWS with the variable-pulse width 595-nm PDL and the 532-nm Nd:YAG laser.
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