Efficacy of early treatment of facial port wine stains in newborns: A review of 49 cases

Background: Port wine stains (PWS) affect 0.3-0.5% of both sexes of newborns, usually occurring on the face. Objective: To document safety and effectiveness of cryogen spray cooled, pulsed-dye laser at higher fluences than previously used to lighten facial PWS in infants <= 6 months, and establish that frequent treatment early in life yields better clearance than if delayed until later in life. Materials and Methods: Forty-nine infants who had been treated with pulsed-dye laser treatments for facial PWS at <= 6 months were identified by case review of photographs, age, sex, PWS severity score prior to laser treatment, number of treatments, and improvement following laser therapy. Results: Patients averaged 9.3 (range 2-16) treatments at 4-6 week intervals at 7.75-9.5 J/cm(2). Average surface area treated was 24.0% with 88.6% average clearance after 1 year. Average clearance was 90.7% for lesions covering < 20% surface area and 85.6% for lesions >= 20%. Location (V1, V2, V3, eye, and/or scalp), treated surface area, treatment number, and fluence predicted clearance. Average clearance for sole involvement of V1 was highest (at 93.8%), followed by V2 (at 91.1%, V3 (at 84.3%), V1/V2 (at 83.7%), V1/V2/V3 (at 81.0%), periocular (at 88.6%), and scalp (at 89.9%). All patients tolerated the higher treatment fluences without atrophy or scarring. Discussion/Conclusions: Frequent, high energy pulsed-dye laser treatments are safe and highly effective in improving facial PWS in infants <= 6 months of age. Patients with PWS should be referred for pulsed-dye laser treatment during early infancy.