Five years' experience of treating port wine stains with the flashlamp-pumped pulsed dye laser.

During the last 5 years, 640 patients had treatment to their port wine stains (PWS) with a flashlamp-pumped pulsed dye laser. One hundred and fifty-six patients have been discharged for varying reasons, of which 59 (38%) achieved excellent (at least 75%) lightening of their birthmark. Of the remaining patients, those who attended the clinic for the sixth and 12th time for treatment were also assessed to determine the degree of fading achieved in the port wine stain. Our findings confirm that flashlamp-pumped dye laser treatment is safe and effective for the treatment of PWS and that complications are rare. However, the degree of fading achieved is variable and often unpredictable. Fifty-two per cent of facial lesions of different colours achieved over 75% fading as against 18% of non-facial lesions. Sixty-four per cent of those over the age of 50 years had an excellent response whereas only 19% of those below the age of 5 years were able to achieve a similar result. The colour of the port wine stain was found to be of no prognostic value. A search for an accurate and non-invasive method to predict the outcome of flashlamp-pumped pulsed dye laser therapy for PWS is warranted.

The clinical spectrum of naevus anaemicus and its association with port wine stains: report of 15 cases and a review of the literature.

Fifteen patients with naevus anaemicus (NA) are reported. Twelve (8%) of 146 patients with a port wine stain (PWS) attending a laser clinic were noted to have this abnormality. In a control population of 298 new dermatology out-patient attenders, specifically examined for the presence of NA, three (1%) further cases were found. The clinical features of patients with NA are described and the literature reviewed. This is the largest group of patients with this disorder described in the English literature. The association of NA and PWS is confirmed. This study suggests that NA is more common than previously considered.

Laser treatment of psoriasis.

In psoriasis, the earliest observable electron microscopic changes are in the dermal papillary vasculature. The flashlamp-pumped pulsed tunable dye laser can achieve selective photothermolysis of the dermal vasculature. This laser was used to treat eight patients with chronic plaque psoriasis, as it was hypothesized that the ablation of dermal papillary vasculature would arrest the early events leading to the evolution of psoriasis, and produce resolution of the plaques. At the final assessment, performed 10 weeks after three fortnightly laser treatments, five of the eight patients recorded an improvement of > or = 50%, and one showed complete resolution of the treated plaques of psoriasis. Although not practicable in the treatment of widespread psoriasis, we conclude that selective photothermolysis of the dermal vasculature by pulsed tunable dye laser offers an alternative new therapy for chronic plaque psoriasis, and also demonstrates the pivotal role of the vasculature in the pathogenesis of psoriasis.