IPL for Port-Wine Stains

  • Ori Samuel Duek
  • Yehuda Ullmann


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.


Intense pulse light Port-wine stains Vascular lesions Selective photothermolysis 


  1. 1.
    Wassef M, Blei F, Adams D, et al. Vascular anomalies classification: recommendations from the International Society for the Study of vascular anomalies. Pediatrics. 2015;136(1):e203–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics. 1976;58:218–22.PubMedGoogle Scholar
  3. 3.
    Chen JK, Ghasri P, Aguilar G, et al. An overview of clinical and experimental treatment modalities for port wine stains. J Am Acad Dermatol. 2012;67(2):289–304.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Kelly KM, Choi B, McFarlane S, et al. Description and analysis of treatments for port-wine stain birthmarks. Arch Facial Plast Surg. 2005;7(5):287–94.PubMedCrossRefGoogle Scholar
  5. 5.
    Jasim ZF, Handley JM. Treatment of pulsed dye laser-resistant port wine stain birthmarks. J Am Acad Dermatol. 2007;57(4):677–82.PubMedCrossRefGoogle Scholar
  6. 6.
    Adatto MA, Luc-Levy J, Mordon S. Efficacy of a novel intense pulsed light system for the treatment of port wine stains. J Cosmet Laser Ther. 2010;12(2):54–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Kalick SM. Toward an interdisciplinary psychology of appearances. Psychiatry. 1978;41:243–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Heller A, Rafman S, Svagulis I, et al. Birth defects and psychosocial adjustment. AJDC. 1985;139:257–63.PubMedGoogle Scholar
  9. 9.
    Malm M, Calber MN. Port-wine stain: a surgical and psychological problem. Ann Plast Surg. 1988;20:512–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Wang B, Wu Y, Zhu X, et al. Treatment of neck port-wine stain with intense pulsed light in Chinese population. J Cosmet Laser Ther. 2013;15(2):85–90.PubMedCrossRefGoogle Scholar
  11. 11.
    Srinivas CR, Kumaresan M. Lasers for vascular lesions - standard guidelines of care. Indian J Dermatol Venereol Leprol. 2011;77(3):349–68.PubMedCrossRefGoogle Scholar
  12. 12.
    Pençe B, Aybey B, Ergenekon G. Outcomes of 532 nm frequency-doubled Nd -YAG laser use in the treatment of port-wine stains. Dermatol Surg. 2005;31(5):509–17.PubMedCrossRefGoogle Scholar
  13. 13.
    Lin XX, Wang W, Wu SF, et al. Treatment of capillary vascular malformation (port-wine stains) with photochemotherapy. Plast Reconstr Surg. 1997;99(7):1826–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Evans AV, Robson A, Barlow RJ, et al. Treatment of port wine stains with photodynamic therapy, using pulsed dye laser as a light source, compared with pulsed dye laser alone: a pilot study. Lasers Surg Med. 2005;36(4):266–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Piccolo D, di Marcantonio D, Crisman G, et al. Unconventional use of intense pulsed light. Biomed Res Int. 2014;2014:618206.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Ross EV, Smirnov M, Pankratov M, et al. Intense pulsed light and laser treatment of facial telangiectasias and dyspigmentation: some theoretical and practical comparisons. Dermatol Surg. 2005;31(9 Pt 2):1188–98.PubMedGoogle Scholar
  17. 17.
    Grillo E, et al. Histochemical evaluation of the Vessel Wall destruction and selectivity after treatment with intense pulsed light in capillary malformations. Actas Dermosifiliogr. 2016;107(3):215–23.PubMedCrossRefGoogle Scholar
  18. 18.
    Raulin C, Hellwig S, Schonermark MP. Treatment of a nonresponding port-wine stain with a new pulsed light source (PhotoDerm VL). Lasers Surg Med. 1997;21(2):203–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Babilas P, Schreml ST, Hohenleutner U, et al. Split-face comparison of intense pulsed light with short- and long-pulsed dye lasers for the treatment of port-wine stains. Lasers Surg Med. 2010;42:720–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Bjerring P, Christiansen K, Troilius A. Intense pulsed light source for the treatment of dye laser resistant port-wine stains. J Cosmet Laser Ther. 2003;5(1):7–13.PubMedGoogle Scholar
  21. 21.
    Ozdemir M, Engin B, Mevlitoglu I. Treatment of facial port-wine stains with intense pulsed light: a prospective study. J Cosmet Dermatol. 2008;7(2):127–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Cliff S, Misch K. Treatment of mature port wine stains with the PhotoDerm VL. J Cutan Laser Ther. 1999;1(2):101–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Ho WS, Ying SY, Chan PC, et al. Treatment of port wine stains with intense pulsed light: a prospective study. Dermatol Surg. 2004;30(6):887–90; discussion 890–1PubMedGoogle Scholar
  24. 24.
    Verkruysse W, Choi B, Zhang JR, et al. Thermal depth profiling of vascular lesions: automated regularization of reconstruction algorithms. Phys Med Biol. 2008;53(5):1463–74.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Dierickx CC, Casparian JM, Venugopalan V, et al. Thermal relaxation of port-wine stain vessels probed in vivo: the need for 1-10-millisecond laser pulse treatment. J Invest Dermatol. 1995;105(5):709–14.PubMedCrossRefGoogle Scholar
  26. 26.
    Lanigan SW. Port-wine stains unresponsive to pulsed dye laser: explanations and solutions. Br J Dermatol. 1998;139(2):173–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Shafirstein G, Baumler W, Lapidoth M, et al. A new mathematical approach to the diffusion approximation theory for selective photothermolysis modeling and its implication in laser treatment of port-wine stains. Lasers Surg Med. 2004;34(4):335–47.PubMedCrossRefGoogle Scholar
  28. 28.
    Renfro L, Geronemus RG. Anatomical differences of port-wine stains in response to treatment with the pulsed dye laser. Arch Dermatol. 1993;129(2):182–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Lanigan SW. Port wine stains on the lower limb: response to pulsed dye laser therapy. Clin Exp Dermatol. 1996;21(2):88–92.PubMedCrossRefGoogle Scholar
  30. 30.
    McGill DJ, Mackay IR. Capillary vascular malformation response to increased ambient temperature is dependent upon anatomical location. Ann Plast Surg. 2007;58(2):193–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Adamic M, Troilius A, Adatto M, et al. Vascular lasers and IPLS: guidelines for care from the European Society for Laser Dermatology (ESLD). J Cosmet Laser Ther. 2007;9(2):113–24.PubMedCrossRefGoogle Scholar
  32. 32.
    Ciocon DH, Boker A, Goldberg DJ. Intense pulsed light: what works, what’s new, what’s next. Facial Plast Surg. 2009;25(5):290–300.PubMedCrossRefGoogle Scholar
  33. 33.
    Railan D, Parlette EC, Uebelhoer NS, et al. Laser treatment of vascular lesions. Clin Dermatol. 2006;24(1):8–15.PubMedCrossRefGoogle Scholar
  34. 34.
    Goldman MP, Weiss RA, Weiss MA. Intense pulsed light as a nonablative approach to photoaging. Dermatol Surg. 2005;31(9 Pt 2):1179–87; discussion 1187.PubMedGoogle Scholar
  35. 35.
    Goldman MP, Eckhouse S. Photothermal sclerosis of leg veins. ESC Medical Systems, LTD Photoderm VL Cooperative Study Group. Dermatol Surg. 1996;22(4):323–30.PubMedCrossRefGoogle Scholar
  36. 36.
    Baumler W, Vural E, Landthaler M, et al. The effects of intense pulsed light (IPL) on blood vessels investigated by mathematical modeling. Lasers Surg Med. 2007;39(2):132–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Black JF, Barton JK. Chemical and structural changes in blood undergoing laser photocoagulation. Photochem Photobiol. 2004;80:89–97.PubMedCrossRefGoogle Scholar
  38. 38.
    Enjolras O, Riche MC, Merland JJ. Facial port-wine stains and Sturge-weber syndrome. Pediatrics. 1985;76(1):48–51.PubMedGoogle Scholar
  39. 39.
    Chapas AM, Geronemus RG. Our approach to pediatric dermatologic laser surgery. Lasers Surg Med. 2005;37(4):255–63.PubMedCrossRefGoogle Scholar
  40. 40.
    Grossman MC. What is new in cutaneous laser research. Dermatol Clin. 1997;15(1):1–8.PubMedCrossRefGoogle Scholar

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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