CHANGES IN SKIN REDNESS, PIGMENTATION, ECHOSTRUCTURE, THICKNESS, AND SURFACE CONTOUR AFTER 1 PULSED DYE-LASER TREATMENT OF PORT-WINE STAINSIN CHILDREN

Background: The pulsed dye laser is the treatment of choice for childr en with port-wine stains (PWSs). Evaluation of treatment outcome and a dverse effects is traditionally based on subjective clinical scoring s ystems. We intend to objectify treatment results and adverse reactions after 1 treatment with the pulsed dye laser. Design: A before-and-aft er 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. Setti ng: A university dermatological department. Results: The skin reflecta nce-determined change in skin redness correlated with the clinical res ponse (r=0.46, P<.002). The percentage of reflectance-determined light ening was equal for pink, red, and dark red PWSs (median, 42.9%). Skin pigmentation increased after laser treatment (P<.007). Ultrasonograph y revealed lower dermal echogenicity of preoperative PWSs than of post operative PWSs (P<.007) and healthy skin (P<.001). An increase in echo genicity reflected a decrease in the dermal water (blood) content. Var iations were found in the dermal localization of the PWS. Skin thickne ss was significantly higher in the PWS before treatment than after (P< .001). The preoperative lesional thickness correlated inversely with t he ultrasound-assessed treatment response (r=0.35, P<.04). The surface contour parameters decreased significantly after laser treatment, ind icating a flattening of the skin surface. The contour changes correlat ed positively with treatment response. By clinical evaluation, no hypo pigmentation or texture changes were detected. Conclusion: The evaluat ion of treatment outcome and adverse effects is refined by the use of skin reflectance, ultrasonographic, and surface contour analysis.