Our Therapeutic Methods with Dye Laser for Portwine Stain Nevus

Abstract

Dye laser irradiation therapy is gradually being recognized as an effective treatment for portwine stain nevus (PWS) because of its selective destruction of abnormal vessels in the nevus. The laser therapy is, however, not always effective, leaving the results unsatisfactory, which is suggesting that something special be added to plain (conventional) dye laser therapy. Having carried out therapeutical studies of 60 patients with PWS, 138 lesions, the authors discuss the results of their methods with dye laser including“marginal compression method”(MC) and“subcutaneous dissecting method”(SD), which are newly devised curative means. Principles of the procedure of MC are compression with a ring-like device at the lesional margin and dye laser irradiation during the compression. The effective rate of the conventional laser was remarkably affected by the histopathological types (superficial type: 75%, diffuse type: 20%) and the lesional sites (neck: 65%, face: 53%, trunk, limbs: less than 20-30%). The difference in the effectiveness between the histological types is due to the limitations of the photological character of the laser beam and its external approach on the skin surface; the deeper the lesional vessels located, the less sensitive are they to the laser. The difference in the effectiveness among the lesional sites is due to that in skin thickness, epidermal melanin contents, etc. In multiple application of dye laser, the conversion rate of ineffective into effective was significantly made up by MC method, which was recognized to make the lesional vessels much more dilated, leading them to be more sensitive to the laser (conventional laser : 29%, MC method: 42%). SD method also impressed its effectiveness in suppressing the recurrence of PWS.