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IPL for Port-Wine Stains

  • Ori Samuel Duek
  • Yehuda Ullmann
Chapter

Abstract

Vascular anomalies can be classified as tumors (characterized by proliferating endothelium) and malformations (normal endothelial turnover). Port-wine stain (PWS) is the most common vascular malformation of the skin, present in 0.3–0.5% of newborns. Seventy to 80% of PWS occur in the face and neck regions, initially appearing as flat, pink-red macules that may gradually thicken and darken with time and may be associated with soft tissue or bone overgrowth.

In the last decades lasers have gained popularity in the treatment of PWS. Though the popular pulse-dye laser has shown benefits in the treatment of superficial PWS, it is not as effective in treating deeper PWS. There are some reasons why PWS may be resistant to treatment: inadequate depth of light penetration, inadequate conduction of heating from the chromophore to the vessel wall, inadequate blood volume (small diameter capillaries do not have enough hemoglobin) and inadequate fluence entering the capillary. Unlike lasers, owing to its variability of pulse and fluence and to its option to divide energy into different pulses, IPL enables additional heating and the coagulation of blood vessels of different diameter and different depth. Moreover, it differs from lasers by its wide spectrum of wavelengths, that leads to different absorption by the skin and a more complex tissue response. IPL respects the principle of selective photothermolysis; the preferential absorption of light by oxy/deoxy-hemoglobin and its conversion into thermal energy, leading to selective coagulation of blood vessels. Various filters can be used (available from 500 nm to 755 nm), that filter out light below the indicated wavelength. In addition, a wide range of other treatment parameters, including pulse duration, fluence, multipulse mode and intrapulse time delay, can be customized and further adjusted from treatment to treatment. The immediate appearance of perilesional erythema, a bluish-purple coloring, blanching or transient purpura is a sign of a good clinical response to the treatment. The usual treatment interval is 4–6 weeks.

We prefer starting treatment early in childhood when they are smaller and more superficially located. The child may be also referred to a pediatric consultation to rule out possible associated abnormalities. Before the treatment parents should be provided with a thorough explanation and matching of expectations should be achieved.

Keywords

Intense pulse light Port-wine stains Vascular lesions Selective photothermolysis 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ori Samuel Duek
    • 1
  • Yehuda Ullmann
    • 1
    • 2
  1. 1.Plastic and Reconstructive Surgery DepartmentRambam Health Care CampusHaifaIsrael
  2. 2.Plastic Surgery “Technion” Faculty of MedicineHaifaIsrael

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