Port-wine stains treated with a pulsed dye laserthe preferred method of treatmentshow significant redarkening years later, reported Dr. Menno Huikeshoven and associates at the University of Amsterdam.
"We recommend that before commencing pulsed dye laser therapy, all patients should be informed of the possibility of redarkening of the stain after treatment," the investigators said in the March 22 issue of the New England Journal of Medicine.
Until now, long-term follow-up data on the results of laser treatment have been scarce and limited to case reports and subjective questionnaires. In this study, Dr. Huikeshoven and associates used objective color measurements to assess treated areas on the face or neck, as well as normally pigmented areas on the contralateral side, in 51 patients who had been treated and similarly assessed in a prospective trial 10 years earlier.
The subjects also completed a questionnaire eliciting their subjective opinion of their treatment results. Their ages at long-term follow-up ranged from 12 to 42 years.
Only color of the lesions was assessed, not other characteristics such as size, surface structure, or degree of hypertrophy, the researchers noted.
The treated areas showed significant redarkening over time, although they remained lighter than they had been before treatment. Of the 51 subjects, 45 sought further pulsed dye laser therapy after their initial five treatments and assessment in the original study.
"It can be concluded that the positive effect of five treatments is not completely durable and that significant redarkening occurs at long-term follow-up," the investigators said (N. Engl. J. Med. 2007;356:123540).
Thirty subjects (59%) reported that they were satisfied with the results of treatment, and 21 (41%) reported they were not satisfied.
The subjects tended to underestimate the changes in color in their port wine stains over time, with only 18 (35%) reporting that they believed their stains had darkened. This is probably because the changes occurred slowly over many years.
This finding highlights the importance of using objective measurements to assess possible changes rather than patient or physician questionnaires, the investigators noted.
In a separate interview with SKIN & ALLERGY NEWS, Dr. Robert A. Weiss of the department of dermatology at the John Hopkins University, Baltimore, said, "I would still recommend the treatment to a patient. Even if there is a bit of recurrence, it is still worthwhile to treat," he said adding that patients can be treated again with the pulsed dye laser after redarkening of the stain to lighten it again. "New lasers have become available since thepatients in this study were treated a decade ago," Dr. Weiss said
The investigators stated that whether the new lasers reduce the incidence of redarkening over time "remains to be investigated."
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