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Merete Haedersdal, MD, PhD; Jan Efsen, MSc; Monika Gniadecka, MD, PhD; Hanne Fogh, MD; Jens Keiding, PhD; Hans Christian Wulf, MD, DSc

Arch Dermatol. 1998;134:175-181.

Background  The pulsed dye laser is the treatment of choice for children with port-wine stains (PWSs). Evaluation of treatment outcome and adverse effects is traditionally based on subjective clinical scoring systems. We intend to objectify treatment results and adverse reactions after 1 treatment with the pulsed dye laser.

Design  A before-and-after trial using skin reflectance to detect changes in skin redness and pigmentation, ultrasonography to evaluate changes in echostructure and skin thickness, and 3-dimensional surface contour analysis to detect changes in surface texture.

Patients  Twelve children with PWSs.

Setting  A university dermatological department.

Results  The skin reflectance–determined change in skin redness correlated with the clinical response (r=0.46, P<.002). The percentage of reflectance-determined lightening was equal for pink, red, and dark red PWSs (median, 42.9%). Skin pigmentation increased after laser treatment (P<.007). Ultrasonography revealed lower dermal echogenicity of preoperative PWSs than of postoperative PWSs (P<.007) and healthy skin (P<.001). An increase in echogenicity reflected a decrease in the dermal water (blood) content. Variations were found in the dermal localization of the PWS. Skin thickness was significantly higher in the PWS before treatment than after (P<.001). The preoperative lesional thickness correlated inversely with the ultrasound-assessed treatment response (r=0.35, P<.04). The surface contour parameters decreased significantly after laser treatment, indicating a flattening of the skin surface. The contour changes correlated positively with treatment response. By clinical evaluation, no hypopigmentation or texture changes were detected.

Conclusion  The evaluation of treatment outcome and adverse effects is refined by the use of skin reflectance, ultrasonographic, and surface contour analysis.

From the Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen (Drs Haedersdal, Gniadecka, Fogh, and Wulf and Mr Efsen), and the Department of Dermatological Research, Leo Pharmaceutical Products, Ballerup (Dr Keiding), Denmark.

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