EFFECT OF DYNAMIC COOLING ON 585-NM PULSED DYE-LASER TREATMENT OF PORT-WINE STAIN BIRTHMARKS

BACKGROUND AND OBJECTIVE. The objective of this study was to determine the effectiveness of a dynamic cooling device (DCD), spraying the ski n with a brief spurt of cryogen prior to the laser pulse, in reducing transient pain associated with 585-nm pulsed dye laser (PDL) treatment of port-wine stains (PWS), and reducing epidermal damage (hypo/hyperp igmentation) caused by this laser during PWS treatment. MATERIALS AND METHODS. Matched treatment sites were compared with and without the us e of the cryogen spray in 47 patients at two investigational sites. Pa in ratings, clearance of the PWS, and pigmentation changes were assess ed. The results were analyzed by skin type and patient age. RESULTS. A statistically significant reduction in pain ratings was found in all patient groups using the DCD without changing the efficacy of PWS clea rance. Pain reduction was most remarkable in patients with darker skin types. Dynamic cooling prevented the occurrence of epidermal damage o r pigmentation change in most cases. CONCLUSIONS. This study suggests that dynamic cooling can dramatically diminish pain during PWS treatme nt with the 585-nm PDL without reducing treatment efficacy. The absenc e of epidermal damage in most patients suggests that precooling with t he DCD may allow the use of higher laser fluences to expedite clearanc e without inducing epidermal change. Dynamic cooling has potential use with other losers and different lesions where discomfort and epiderma l effects limit therapy. (C) 1997 by the American Society for Dermatol ogic Surgery, Inc.