Weekly PDL treatments associated with improved port-wine birthmark therapeutic outcomes in infants

Weekly PDL treatments associated with improved port-wine birthmark therapeutic outcomes in infants | Image Credit: © guentermanaus - © guentermanaus - stock.adobe.com.

Once-weekly pulsed dye laser (PDL) treatments among infants with port-wine birthmarks (PWB) aged younger than 6 months were associated with near-total or total clearance of PWB, which suggested improved outcomes are achievable with shorter overall treatment duration. Findings were from a case series recently published in JAMA Dermatology, and according to the study authors, treatments were well tolerated.

The investigative team led by Shirin Bajaj, MD, of Laser & Skin Surgery Center of New York, New York, noted there has been increasing evidence that shorter treatment intervals could play a role in rapid PWB clearance. PWB, a low-flow congenital vascular malformation that can present as an isolated lesion or part of a syndrome, can become ectatic and pink macular lesions that turn darkened overtime as they evolve.

"In some cases, the lesions can become symptomatic proliferative nodules or pyogenic granulomas, which can be problematic due to its proclivity for bleeding," the investigators wrote. "Untreated facial PWB and related facial disfigurement are associated with substantial psychosocial disturbance in both childhood and adulthood."

To determine the outcomes of the once-weekly PDL treatment for PWB in infants, among the first few months of life, the case series design analyzed medical records of patients with PWB who received the treatment between January 1, 2022, and December 31, 2023. Treatment was received at the Laser & SKin Surgery Center of New York and patients included were younger than 6 months of age.

Percentage improvement of PWB was the primary outcome of the study, graded using the following scale:

• 0% (no improvement)
• 1% to 25% (mild improvement)
• 26% to 50% (moderate improvement)
• 51% to 75% (marked improvement)
• 76% to 95% (near-total clearance)
• 96% to 100% (total clearance)

Patients were treated with a novel PDL (VBeam Prima; Candela Corp) at a spot size of 13 mm fluence ranging between 6.5 and 8 J/cm² and a pulse duration of 1.5 ms, according to authors. All PDL treatments were performed by 2 laser surgeons and hair-bearing sites such as eyebrows and scalp were not treated. These sites were used as internal controls. Before-and-after photographs of each PWB were assessed and graded by 2 dermatologists.

Of the 10 patients in the study (60% male) who had a median age at first treatment of 4 weeks (<1 to 20 weeks), 7 patients had experienced either near-total clearance (76%-95%) or total clearance (96%-100%) of their PWB with once-weekly PDL treatments after 2 months.

Marked improvement (51-75%) was observed in the other 3 patients, who went on to achieve near-total clearance with additional treatments. No adverse events were noted, and the median (range) duration of treatment and number of treatments to achieve near-total clearance in all patients were 2 months (0.2-5.1 months) and 8 treatments (2-20 treatments), the investigators wrote, respectively.

"These findings suggest that during the first few months of life, once-weekly PDL treatments for PWB, which were well tolerated due to the absence of posttreatment-related purpura in this age group, are associated with improved therapeutic outcomes and shorter overall treatment duration," stated the study authors in their conclusion.

The authors noted further investigation into the novel decreased treatment interval of 1 week is warranted.

Reference:

Bajaj S, Tao J, Hashemi DA, Geronemus RG. Weekly Pulsed Dye Laser Treatments for Port-Wine Birthmarks in Infants. JAMA Dermatol. 2024;160(6):606–611. doi:10.1001/jamadermatol.2024.0293.