Potential efficacy of fractional CO2 laser in treating port wine stain birthmarks with hypertrophy

Dear Editor,

Port wine stain birthmarks are congenital vascular diseases caused by excessive capillary dilation, leading to red or purple skin discoloration. As patients age, the lesions often thicken, with 65% developing hypertrophy. Dilated vessels typically range from 10-150m in diameter and are located 0.6 mm under the skin, but in hypertrophy, they can reach up to 500m and extend to 3.7 mm deep.1 Current treatments, including various lasers and photodynamic therapy, target hemoglobin based on the theory of selective photothermolysis. However, these treatments often fall short, especially in patients with hypertrophy. For example, Pulsed Dye Lasers (PDL), the gold standard, may not fully photocoagulate vessels outside the 20-150m range, dense blood vessel areas, or vessels located deeper than 0.65mm. Potassium Titanyl Phosphate (KTP) lasers and photodynamic therapy may work better on smaller vessels but are limited by epidermal thickness and melanin. Neodymium: yttrium-aluminum-garnet (Nd: YAG) lasers can occlude deeper vessels more effectively than PDL but carry a higher risk of scarring. [...]