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Despite rapid advances during the past two decades there are still unanswered questions
There have been numerous advances during the past two decades in the treatment of birthmarks, concerning both efficacy and safety. Although initial results of laser treatment for portwine stains are encouraging, there remain unanswered questions about the long term benefits. The response of other birthmarks to laser therapy is variable, and much work still remains to be done.
PORTWINE STAINS
Laser treatment has become the standard of care for the management of portwine stains. The past two decades have witnessed the progression of these devices from crude, non-selective forms of treatment to highly sophisticated lasers capable of selective photothermolysis. In spite of this, the results of treatment leave much to be desired. Although the vast majority of portwine stains lighten significantly with treatment, only 15–20% clear completely.1 Moreover, a recent disturbing report revealed what many of us had suspected for some time: portwine stains can recur after treatment.1 The implications of this are yet to be determined. These findings lead to several important questions: why are we not able to clear more lesions and have there been any recent developments to improve our results?
Vessel depth
Two of the most important considerations are the depth of the vessels and their diameter. For some time, we have known that there is a significant variation in the depth of the vessels in portwine stains. Given the limited depth of penetration of yellow light (1–2 mm at 585 nm), our inability to effectively treat the full thickness of some of the lesions seemed inevitable. Recent work has shown that there is indeed a correlation between the depth of the vessels and the response to laser treatment.2 In lesions where the mean depth of the vessels is greater than 1030 μm, the …