Pulse Dye Laser
Portwine stain
This is a blood vessel abnormality affecting up to 0.5% of the population. It looks like a pink patch at birth and will not go away. Instead, as one grows older the birthmark will steadily darken and become larger. By midlife, many of those afflicted with the condition may suffer from cosmetic disfigurement, which can occur on any part of the body. If the birthmark becomes too large or thick it may bleed.
Strawberry haemangiomas
These are overgrown or enlarged vessels which grow very rapidly after birth but often go away with time. The birthmark usually resolves by 5-6 years. Some, however, may occur near the mouth or eyes and interfere with eating or vision. They should be treated early before problems set in. Sometimes the birthmark may bleed or become infected.
Spider naevi
Like strawberry haemangiomas, spider naevi are overgrown or enlarged blood vessels. Each spider naevus consists of a central large blood vessel with tiny vessels radiating from the centre, hence the name. They usually do not cause problems except that they look unsightly. These spider naevi may be associated with an underlying chronic liver disease.
Many people are uncomfortable with unsightly birthmarks. Young children or infants can be treated before they are subject to the psychological as well as physical blemishes that may be associated with the birthmarks. Sometimes birthmarks may bleed, become infected or interfere with vision, eating or other bodily activities.
The flashlamp pulsed dye laser is able to selectively treat the blood vessels of the birthmark without adversely affecting the surrounding tissues. Thus, it will eliminate many lesions while leaving the surrounding skin and skin pigment intact, thus reducing scarring. This treatment is safe to be used on infants as young as a few weeks old.
The treatment varies from patient to patient depending on the type of birthmark, size of the affected area, colour of the skin and the depth to which the abnormal vessels extend beneath the skin surface.
The steps involved are:
1. The doctor will test your skin reaction to the laser during your first visit to determine the most effective treatment.
2. Because the laser operates at a wavelength that is potentially harmful to the eye, you will be asked to wear eye-protective goggles.
3. Treatment consists of placing a small handpiece or “wand” against the surface of the skin and activating the laser. The flashlamp pulsed dye laser will strike the skin in an intermittent fashion. Each pulse feels, for a small fraction of a second, like the snapping of a small rubber band against your skin.
4. Small birthmarks like spider naevi, will require only a few pulses while others, like portwine stain will require many more. Large birthmarks will require retreatment, necessitating multiple patient visits.
Most adults tolerate treatment without the need for anaesthesia, although treatment of larger lesions may be less comfortable, necessitating the use of topical anaesthetic cream. Children and particularly infants may have a lower pain threshold, and may tolerate the procedure better with the use of sedatives or general anaesthesia.
Immediately after treatment, the laser-treated area will turn dark-grey. This will persist up to two weeks until the dead red blood cells are cleared internally by the special cells in your skin. Occasionally, a very thin scab will form on the surface of the skin. This will fall off within two weeks.
In the first few hours after treatment, the laser-treated area may feel hot, like a sunburn. You may relieve this by applying cool cloth soaked in cold water, or you can use cloth wrapped around ice cubes or an ice pack.
For the next three to four days:
- avoid hot water contact to the face
- avoid hot conditions e.g. sauna, spa
- you can wash the face with tepid water but avoid soaps and rubbing or friction on the skin
- avoid or minimise sun exposure
- you may use moisturiser on the face if it is applied gently and not rubbed in
After the first four days, you may use a sunscreen if you are going outside. It is very important that you avoid excessive sun exposure for the first 3 months. Otherwise brownish pigmentation may occur which may take a few months to fade.
Optimal results will be achieved with the flashlamp pulsed dye laser only if you are not sun-tanned. It is also recommended that you avoid exposing the treated area to the sun and cover the area with a sunblock that is approved by your doctor. Of course, this area may be exposed to the sun when your course of treatment is complete.
Patients with tanned or darker skin types will achieve less satisfactory results from this form of treatment.
The cost per treatment ranges from $200 to $2,500 depending on the size of the lesion treated. Most patients will require about 4-6 treatment sessions.