Port-wine birthmark treatment with once-weekly pulsed dye laser works well for infants

Administering once-weekly pulsed dye laser (PDL) treatments to infants with port-wine birthmark in the first few months of life appears safe and leads to significant improvements in the involved skin areas, as shown in a small retrospective study.

In a case-series analysis of 10 infants who were younger than 6 months, 70 percent achieved either near-total clearance (76 percent to 95 percent) or total clearance (96 percent to 100 percent) of their port-wine birthmark following 2 months of once-weekly PDL treatments. [JAMA Dermatol 2024;doi:10.1001/jamadermatol.2024.0293]

The remaining 30 percent showed marked improvements (51 percent to 75 percent) and eventually achieved near-total clearance with additional treatments, the investigators noted.

Overall, PDL treatment took a median of 2 months (range, 0.2–5.1) and a median of eight sessions (range, 2–20) to achieve near-complete or total clearance.

The treatment was well tolerated, according to the investigators. None of the infants had any adverse events, including post-treatment purpura or pigmentary alterations, scarring, burns, erosions, or infections.

Of the infants, 60 percent were male and 80 percent had Fitzpatrick Skin Type I to III. Treatment was initiated at a median age of 4 weeks. At baseline, PWB size was <20 cm² for two infants, between 20 and 39 cm² for another two, and >40 cm² for the remaining six (including three whose birthmark was >200 cm² and had both facial and extra-facial involvement). Three infants had involvement of the trunk, with two presenting with both upper and lower limb involvement, whereas the other seven had birthmark either on the head or neck without body involvement.

“These [findings] are compelling and warrant attention and further investigation into the possibility that this novel and decreased [PDL] treatment interval of 1 week, made possible by the absence of post-treatment-related purpura, is associated with potential improvement in outcomes and shorter overall treatment duration,” the investigators said.

Treat them young

The rationale behind the approach of giving PDL treatments once a week to very young infants with port-wine birthmark was twofold, they said.

First, starting treatment early leads to better results, potentially due to the thinner dermis in babies’ skin allowing for better targeting of smaller, more superficial blood vessels with minimal light scattering. Also, infants under 3 months old are less likely to experience side effects from the laser (ie, post-treatment purpura), reducing healing time between sessions. This allows for more frequent treatments during a critical growth period when port-wine birthmark may be most responsive to PDL therapy, potentially resulting in faster overall treatment completion, as the investigators pointed out. [JAMA Dermatol 2019;155:435-441; J Am Acad Dermatol 2008;58:261-285]

“Furthermore, early treatment is a more practical way to treat infants, who are easier to stabilize during treatments, and, although controversial, mitigates the potential need for repetitive exposure to general anaesthesia, which can pose both a safety and financial burden to families,” they said.

The investigators also stressed that all infants in the study achieved significant with once-weekly PDL despite the fact that more than half of them presented with port-wine birthmarks exceeding 40 cm² and/or involving the central face or extremities—factors known to make treatment more challenging.

The success in this case series suggests that early intervention and more frequent treatments might be beneficial in clearing conventionally challenging port-wine birthmarks, they concluded.