Erasing Skin Marks with Lasers

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Erasing Skin Marks with Lasers
by Ricki Lewis, Ph.D.
FDA Consumer magazine

This article was published in FDA Consumer magazine several years ago. It is no longer being maintained and may contain information that is out of date. You may find more current information on this topic in more recent issues of FDA Consumer or elsewhere on the FDA Website, by checking the site index or home page, or by searching the site.

Erasing Skin Marks with Lasers
by Ricki Lewis, Ph.D.

Port-wine stains can make life difficult for people of all ages. Donna
Arnds, a 23-year-old from north Los Angeles, has marks on her nose, eyelids
and lips. In high school, she never attended a dance because, she says, no
one wanted to be seen with her. Anne Plescia, 40, of Ithaca, N.Y., was often
mistaken to be mentally retarded because of her facial birthmarks. "I've
been in conversations where they will only address my husband, assuming I
have no intellect," she says.

Thousands of parents have agonized as their birthmarked children approach
school age "when the kids are old enough to be cruel," notes Linda Margalith
of Beverly Hills, Calif., mother of 3-year-old Alexa.

For Gina Brass of Escondito, Calif., the suffering was even worse. Many
people who saw the marks on her 6-year-old daughter's cheek and chin would
accuse her of physically abusing the child, causing her "bruises." These and
many other people with birthmarks have been helped by a new type of
treatment using laser devices, which are regulated by the Food and Drug
Administration. The treatments for benign (noncancerous) skin lesions
possible with lasers extend beyond birthmarks, to include liver spots,
spider veins, residual redness following plastic surgery on the nose, and
even tattoo removal.

The temporary redness, swelling, and a bruised appearance that can occur
after laser treatment of the skin are preferred by some patients to the
discomforts of older methods, which include freezing tissue with liquid
nitrogen, electrosurgery, scraping off (curettage) the affected area,
treating the area with chemicals such as Retin A (tretinoin) or acids, or
masking marks with make-up. When used by physicians who are trained in the
use of a laser, results can be quite dramatic. But in less well-trained
hands, a laser can cause damage and scarring, just as traditional surgery or
scraping can.

Lasers used in these treatments include: carbon dioxide, argon, continuous
tunable dye, ruby, copper vapor, and flashlamp-pumped pulsed dye (see
accompanying article). Here is a rundown on what these new lasers can do
when applied to the skin.

Port-Wine Stains

A beet-colored mark splashed across a small face can be the butt of many
children's jokes.

"Reaction depends on the individual child, but especially when one hits
school age, the teasing is unbelievable," says Tina Dawn, president of the
National Congenital Port-Wine Stain Foundation in New York City. "I've known
children to throw their eyes out of whack because they constantly keep their
heads down to hide the stain," she adds. For these children, successful
treatment can literally turn their lives around.

Because the idea of a laser can be frightening, the staff at the University
of Massachusetts Medical Center in Boston gives each patient a Raggedy Ann
or Raggedy Andy doll that has a matching mark made in red crayon. The doll
receives a laser treatment to show the child how the mark disappears, and to
quiet fears.

To remove a port-wine stain, a small area on the patient's arm is first
tested, and then the mark is treated. Anesthesia is not used unless the area
to be treated is extensive, and then local anesthesia is used.

The laser feels like a small rubber band being snapped against the skin. For
the first 24 hours, the area swells and reddens, the signs of the body's
immune response to the vaporized blood vessels in the birthmark. The area
turns a bluish-gray with purplish-red spots for 7 to 10 days. The spots
fade, and the treated area continues to lighten over the next eight weeks.

But it may be difficult to locate a physician who is experienced with this
relatively new procedure. "The average dermatologist has yet to have a laser
available, but more and more are getting them, says Dawn. "Now, only
specialized medical centers and some dermatologists have them."

Using the flashlamp-pumped pulsed dye laser to treat port-wine stains
requires more sessions to fade the mark than with other lasers, and bumpy
lesions do not respond well.

Still, this type of laser is currently the one recommended to treat
children--and the sooner the lesion is treated, the better the results. Blas
Reyes, M.D., and Roy Geronemus, M.D., of the New York University Medical
Center, treated port-wine stains in 73 patients between the ages of 3 months
and 14 years, and discovered three reasons to zap a port-wine stain as soon
as possible:
- the skin thickens up to age 20, when it becomes more difficult to treat
- the extraneous blood vessels are smaller in diameter in a youngster
- the stain itself occupies a smaller area in the young.

Complete article may be viewed online.