Modifications to existing laser technology as well as a combination laser can help treat various types of port wine stains more effectively than in the past, according to Jeffrey Dover, MD, FRCPC, a dermatologist with SkinCare Physicians.
Although the pulsed dye laser is the "gold standard" in therapy, other laser and light-based devices, such as long-pulsed 532-nm lasers, long-pulsed Nd:YAG lasers, intense pulsed light devices, and a combination pulsed dye laser and long-pulsed Nd:YAG laser can be used to treat stubborn, thick, large, or nodular port wine stains.
"Early results with a combination of the pulsed dye laser and a long-pulsed Nd:YAG laser have been very promising," Dover says, noting the long-pulsed Nd:YAG laser requires increased skill and must be used judiciously.
Original investigations suggested that most port wine stains cleared totally in a matter of six treatments.
It has become evident that far more treatments—12 or more—are needed to achieve good results, and complete clearing of port wine stains is rare.
A newer device called the Cynergy (Cynosure) is a combination device made up of two lasers: a pulsed dye laser and a long-pulsed Nd:YAG laser. It can be used as either a pulsed dye laser or as a long-pulsed Nd:YAG laser, or the two lasers can be used in combination.
"They fire one right after the other. When you get set up, on the control panel you may select the PDL, the Nd:YAG, or both lasers.
"If you select both, you choose the energy and pulse duration of each and the delay between the two lasers firing—the pulsed-dye laser first, followed by the Nd:YAG laser," says Dover, who has been using the device for about a year.
Dover says he has used the combination laser for never-before-treated flat and thick port wine stains as well.