Br J Dermatol. 2008 Dec 11

Pulsed dye laser vs. intense pulsed light for port-wine stains: a randomized side-by-side trial with blinded response evaluation.

Faurschou A, Togsverd-Bo K, Zachariae C, Hædersdal M.
Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark.

This study is from the same Denmark group that recently compared the pulse dye laser (LPDL) to the intense pulsed light (IPL) for the treatment of photoaging.  In this study, Annesofie Faurschou reports another head-to-head study comparing these two device types, this time for the treatment of portwine stains.  The study was supported by the laser manufacturer and the local sales agent for the IPL, but neither sponsor participated in the conduct or analysis of the study.  In particular, this study compared the Candela VBeam Perfecta (long pulse 595nm dye laser) with the Palomar StarLux IPL with a Lux G handpiece.

The study was adequately, though not optimally, designed to demonstrate the differences with each type of treatment.  First, each study participant received one split-lesion treatment, with the one half of the lesion randomized to each device type, which properly controls for non-study effects (e.g. additional sun exposure).  The use of a split-face design also appropriately controls for patient variability.  However, the use of a series of multiple treatments would have magnified any possible outcome differences, and would better reflect clinical practice.   Second, one evaluation was performed photographically by a blinded assessor.  Blinding appropriately prevents bias, but the introduction of photographic artifact may obscure outcome differences.  Third, a second evaluation was performed with a skin reflectance meter, also performed by a assessor blinded to device-types used on each half.  Blinding appropriately prevents bias, but this meter has been validated for the use of evaluating erythema and pigmentation rather than portwine stains.

In this study, while both devices achieved measurable PWS lightening and no adverse events were found, the pulsed dye laser showed superior efficacy, both by blinded photographic evaluation and by blinded skin photometer.  The difference in lightening was both statistically and clinically significant (i.e. the difference in lightening was visually apparent to the blinded reviewer and the patient), even though only one treatment was performed.  As far as patient preference, 18 of 20 patients preferred to have subsequent treatments with the LPDL, while 2 preferred the IPL.

The superior results of the pulse dye laser may not be considered definitive based solely on this study, as there was no-pre-defined study hypothesis to be proven.  However, the authors refer to several other studies to underline their proposal that the LPDL be considered the first choice modality for PWS treatment, with the IPL reserved for poor-LPDL-responders.  This is an appropriate guideline.