Treatment of Port-Wine stains during infancy safe, effective even without anaesthesia
Port-Wine stains (PWSs) can be effectively and safely treated during infancy using pulsed dye laser, without the need for general anaesthesia, according to a new study.
“In our study, we were able to achieve 100-percent clearance of the vascular birthmark in 34.0 percent of patients younger than 1 year. We also found that the presence of a V1 lesion [first branch of the trigeminal nerve] was associated with a statistically significant higher clearance rate,” said researchers.
By accessing medical records, researchers performed a retrospective cohort study on 197 patients (mean age 3.38 months; 62.9 percent female) who started pulsed dye laser treatment at age ≤1 year. Most of the lesions (75.6 percent; n=149) were located on the face, while the remaining were on the trunk or extremities. The mean lesion size was 61.09 cm2. [JAMA Dermatol 2019;doi:10.1001/jamadermatol.2018.5249]
More than a quarter (25.9 percent; n=51) of the participants showed 100-percent lesion clearance, according to a 5-point visual analogue scale accomplished by four physicians who based their grading on before and after photographs.
Using the same system, 41.1 percent (n=81) showed 76–99 percent improvement, 22.3 percent (n=44) showed 51–75 percent improvement, 6.6 percent (n=13) showed 26–50 percent improvement, and only 4.1 percent (n=8) showed 0–25 percent improvement.
The mean visual analogue scale score for the overall cohort was 3.65, corresponding to excellent clearance. Analysed according to site, facial lesions earned a mean grade of 3.69, while nonfacial lesions garnered a score of 3.57.
Of those with facial lesions, 19.8 percent had a V1 distribution, while 32.0 percent and 4.6 percent had lesions in the second (V2) and third (V3) branch of the trigeminal nerve, respectively. Mean visual analogue scale grades for these groups were 3.98, 3.70 and 3.17, respectively.
Multiple linear regression analysis showed that having a V1 lesion was associated with a significantly higher likelihood of a higher clearance rate, increasing the visual analogue scale grade by 0.55 (95 percent CI, 0.25–0.84; p<0.001) points. This remained true after controlling for lesion size and patient age. In comparison, having a V3 lesion was associated with reduced clearance rate, lowering visual analogue scale grades by 0.47 (–0.91 to –0.02; p=0.04) points.
“We believe the rationale and the data that we present herein support early in-office treatment, particularly when the treatment can be performed with minimal risk for complications,” said researchers, noting that treatment delivered during infancy eliminates the need for general anaesthesia.
“With the growth of the child, it becomes more challenging to keep the patient stabilized for the duration of the treatment,” they continued. “Given that frequent treatments are often necessary to achieve acceptable clearance, being able to treat children without having to frequently expose them to general anaesthetic and sedation drugs offers a safety advantage and cost savings.”
“Additional studies, particularly evaluating long-term outcomes, on the safety and effectiveness of treating PWSs during infancy would be beneficial and further guide clinicians,” they added.