BRIEF COMMUNICATION / CASE REPORT
Treatment of Port-Wine Stains by Variable Pulse Width
Pulsed Dye Laser with Cryogen Spray: A Preliminary Study
Wendy W. Lou, MD and Roy G. Geronemus, MD
Laser and Skin Surgery Center of New York, New York, New York
PULSED DYE LASER (585–600 nm, 450 ꢀsec or 1.5
msec) has been the treatment of choice for port-wine
stains for nearly two decades. Although the wave-
length of the laser was chosen in accordance with the
theory of selective photothermolysis, it has been sus-
pected that longer pulse widths may be optimal in tar-
geting the different-sized vessels and diminishing or
eliminating the post treatment purpura seen with the
traditional pulsed dye laser.1 Recently a PDL with
variable pulse widths was designed in response to
these issues.
ence, longer pulse widths appear to be associated with
fewer purpura and side effects. In addition, severe pur-
pura and any persistent whitening immediately after
laser irradiation seem to correlate with side effects
such as hypopigmentation and atrophic changes of the
epidermis.
Table 1. Fluences and Pulse Widths Tested on Patient 1 with 30
msec Cryogen Spray and 30 msec Delay and 7 mm Spota
Fluences 4 J/cm2 5 J/cm2 6 J/cm2 8 J/cm2 10 J/cm2 15 J/cm2
The purpose of this study was to determine the flu-
ences and pulse widths for the safe and effective treat-
ment of truncal port-wine stains using the variable pa-
rameters of this new PDL. Two adult subjects with
previously untreated port-wine stains on their backs
were tested at various fluences and pulsed widths. Pa-
tient 1 is a 39-year-old man who underwent testing
with the parameters shown in Table 1. Patient 2 is a
31-year-old woman who was treated with the parame-
ters shown in Table 2.
1.5 msec
10 msec
20 msec
30 msec
40 msec
P1
W0
P0
W0
(not
tested)
P1
W0
P1
W0
P1
(not
(not
P3
W1
P2
W0
P2
W0
P2
W0
P2
P3
W3
P2
W2
P2
W2
P2
W1
P2
tested) tested)
P1
W0
P1
W0
(not
P1
W0
P2
W0
(not
W0
(not
(not
tested) tested) tested) tested)
(not
tested)
P0
W0
P0
W0
P1
W0
W0
W1
For patient 1, the degree of purpura and persistent
whitening after treatment are summarized in Table 1.
The amount of clearance and side effects at the 3.5-
month follow-up evaluation are presented in Table 3
(Figure 1). For patient 2, the degrees of purpura and
persistent whitening after treatment are shown in Ta-
ble 2. The amount of clearance and side effects at the
2-month follow-up evaluation are summarized in Ta-
ble 4 (Figure 2).
a Evaluation at least 10 minutes after laser test for purpura (P) and persistent whit-
ening (W) (0 ꢁ none, 1 ꢁ mild, 2 ꢁ moderate, 3 ꢁ severe)
Table 2. Fluences and Pulse Widths Tested on Patient 2 with 30
msec Cryogen Spray and 30 msec Delay and 7 mm Spota
Fluences
7.5 J/cm2
10 J/cm2
13 J/cm2
15 J/cm2
1.5 msec
P2
W0
P3
W0
P3
W0
(not tested)
Although a strict correlation of parameters and
clinical responses varies with the individual patient
and the anatomic site of the lesion, some general ob-
servations and clinical correlations may be derived
from our two subjects.
In general, the degree of purpura roughly correlated
with the degree of lesional clearance. In our testing, no
clinically detectable clearance was noted at sites that
did not attain purpura (Figure 3). At a constant flu-
(10 mm)
P2
W0
(10 mm)
P1
W0
P1
W0
(not tested)
3 msec
P3
W0
P3
W0
(not tested)
(not tested)
6 msec
P2
W0
P2
W0
P1
W0
P1
W0
P1
P3
W0
P3
W1
P2
W2
P2
W2
P2
10 msec
20 msec
30 msec
40 msec
P3
W2
P3
W3
P3
W3
P3
W0
(not tested)
(not tested)
W.W. Lou, MD and R.G. Geronemus, MD have indicated no signifi-
cant interest with commercial supporters.
W0
W0
Address correspondence and reprint requests to: Roy G. Geronemus,
MD, 317 E 34th St., 11N, New York, NY 10016.
a Evaluation at least 10 minutes after laser test for purpura (P) and persistent whit-
ening (W) (0 ꢁ none, 1 ꢁ mild, 2 ꢁ moderate, 3 ꢁ severe)
© 2001 by the American Society for Dermatologic Surgery, Inc. • Published by Blackwell Science, Inc.
ISSN: 1076-0512/01/$15.00/0 • Dermatol Surg 2001;27:963–965
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