Mapperley Park Clinic

Treating Port Wine Stains with the Pulsed Dye Laser

What is a Port Wine Stain?
Port Wine Stains are caused by a genetic abnormality of the sub-surface micro-vasculature where small 'loops' of capillaries are thrown to the surface above the normal net of blood vessels. The increased quantity of blood flowing just beneath the skin surface is clearly visible through the skin as a discreet patch of red, pink or even purple skin.

What can be done to remove a Port Wine Stain?
There are a number of lasers that can target blood vessels. Our Pulsed Dye Laser was specifically designed to target sub-surface blood vessels and, after many years of safe use, is still the treatment of choice for a range of vascular conditions.

The Pulsed Dye Laser works by producing a carefully calculated pulse of yellow light that damages the blood vessels that cause Port Wine Stains without damaging the surrounding tissue.

Does it work?
Unfortunately, Port Wine Stains vary quite widely and do not always respond predictably. The response will vary from excellent to disappointing, although all Port Wine Stains will respond to some degree or other.

In general, the nearer the vessels are to the surface, the better the result: the nearer the vessels are to the surface, the more visible is the Port Wine Stain. Consequently, a deeper red, or purple Port Wine Stain is likely to respond better than a pink Port Wine Stain.

What is the procedure?
Multiple treatments, spread at least 8 weeks apart are normally required. Anywhere between 4 and 10 treatments will be required to take the skin to its optimum improvement. To determine the optimum power to be used, a test patch is first required. This will be a group of laser pulses, covering a range of power settings, that will establish at the 8 week follow up:

• Which power setting produces the best response
• How effective the response has been

Once a full treatment programme has been decided, the entire Port Wine Stain will usually be treated, although in large cases, it may be spread over a number of treatments. Over the course of a number of treatments, the Port Wine Stain will usually reduce in both intensity and size.

Are there any side effects to the treatment?
The main side effect is a short-lived 'pupuric bruising' of the skin where the targeted blood vessels disintegrate under the laser pulse. Purpuric bruising will be noticeable as round purple spots that will last for a week or two before fading away. Small areas may 'crust' or blister but these will usually settle down within a day or two.

Long term side-effects are very rare: up to a quarter of patients experience a transient increase in skin pigmentation that can last for weeks, or even months after treatment. Other very low risks, affecting less than 1% of patients include, hypo-pigmentation and scarring. The treatment is so safe, compared with other lasers, that it is the treatment of choice even on babies and children.

What does the treatment feel like?
There is no denying the fact that it hurts! However, the first treatment is the most painful. As the Port Wine Stain reduces, less power is absorbed and less pain is felt.

Quite high powers are being absorbed at the level of skin pain-receptors and this is felt as a sting followed by a hot, itching sensation. Your ability to tolerate any pain largely depends on your pain threshold but in any case, we have ways of reducing the pain including:

• Chilled air cooling: this reduces the heat generated.
• Topical anaesthetic (EMLA cream): can be applied before treatment.
• Local anaesthetic injection: can further reduce the pain felt.
• Post treatment cooling: also reduces incidence of blistering

Whether, or what pain relief is needed can be established at the time of any test shots. Your treatment plan will include pain relief, which can be reviewed at any time during treatment.

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