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Port-Wine Stains Can Return After Laser Treatment

 Laser treatment of port-wine stains can lighten these disfiguring facial blemishes, but its effect may not be permanent, new research suggests.

A team from the Netherlands concluded that port-wine stains treated with pulsed-dye laser therapy often re-darken after a number of years.

"Although pulsed-dye laser treatment of port-wine stains is still the best and most effective method currently available, patients should be aware of the fact that the effect of this treatment may not last forever and that the port-wine stain may return -- in part -- at long-term follow-up," said Dr. Menno Huikeshoven, a plastic surgery resident at Academic Medical Center at the University of Amsterdam in the Netherlands.

His team reported its findings in the March 22 issue of the New England Journal of Medicine.

A port-wine stain is a reddish-purple birthmark that often appears on the face. About three out of every 1,000 Americans has a port-wine stain, according to the National Library of Medicine. Former Soviet president Mikhail Gorbachev was perhaps the most famous figure to have such a blemish.

These skin discolorations are often present at birth but may be much lighter in babies and young children. Port-wine stains tend to darken with age.

Before laser treatments became available, port-wine stains were treated with freezing, radiation, tattooing and even surgery. Those methods could cause scarring, however. In contrast, pulsed-dye laser treatments have a low incidence of side effects, according to Dr. Barry Auster, a dermatologist at Providence Hospital and Medical Center in Southfield, Mich.

"Pulsed-dye laser is one of the most safe, predictable treatments we have," said Auster.

The number of treatments needed depends on the size and the darkness of the stain, according to Huikeshoven. Auster said an initial series of between six and eight treatments spaced about 60 to 90 days apart isn't uncommon.

Because the treatment is relatively new -- it was introduced in the mid-1980s, according to Auster -- information on the long-term results of laser treatment has been scarce.

To objectively assess the long-term efficacy of pulse-dyed laser, the researchers obtained color measurements from 51 people who had undergone laser therapy to lighten port-wine stains. The average follow-up was 9.5 years.

On average, stains did tend to darken again over time. "Although the laser-treated port-wine stains were still significantly lighter than before the treatment, significant re-darkening had occurred over the past 10 years," Huikeshoven said. "This means the treatment effect is not entirely persistent."

Still, most patients remained happy with the treatment. The study found that 59 percent of those treated with pulsed-dye laser were satisfied with their results, and an equal number felt that their stain hadn't become darker since their last treatment. About 35 percent felt their stain had become darker since treatment.

"This may not be forever," said Dr. Seth Orlow, chairman of the department of dermatology at the New York University Medical Center. "The bottom line is that not everybody's results are permanent, but that's not the end of the world. You can get touched up again," he explained.

All three experts concurred that laser treatment is still the gold standard treatment for port-wine stains, and the procedure has a very low incidence of adverse events.

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