Role of Laser in Vascular and Pigmented Birthmarks

The pulsed dyed laser (PDL) is the gold standard for the treatment of vascular lesions in children. The treatment end point is purpura. Numerous sessions are needed to lighten port- wine stains (PWS). Only about 20% of patients obtain complete clearance and recurrence may occur. Laser resistant PWS had higher blood flow, larger vessel diameters & located deeper in the skin. Most hemangiomas do not require treatment. PDL is useful in the management of ulcerated hemangiomas, superficial facial hemangiomas & remove residual telangiectasia after involution. In my practice, moderate to high fluences with long pulse duration are used to treat hemangiomas.
Pigment lasers e.g. nanosecond (ns) & picosecond (ps), alexandrite (755nm), Nd:YAG (1064/532nm) are effective in removing pigmented lesions by targeting melanosomes.
Pigment laser treatment should be initiated at the minimum fluence, which causes an immediate tissue-whitening. Lentigines can be treated effectively using PDL with compression with a low risk of post inflammatory hyperpigmentation. Use of a low-fluence Q-switched 1064nm Nd:YAG laser has been used to treat café-au-liat macules & nevus of Ota effectively with fewer side effects. Careful selection of laser parameters & patient education are pivotal.