Erasing skin marks with lasers - includes related article on medical use of lasers - Cover Story

FDA Consumer, March, 1992 by Ricki Lewis

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.

Spots, Freckles, Moles, and Spiders

A cousin to the vascular lesion laser" used to treat port-wine stains is a pigmented lesion laser, which FDA cleared for use in May 1991. It is used to treat lentigines also known as age, sun or liver spots), moles, freckles, and brown birthmarks, which millions of people have. This laser zeroes in on melanin, the pigment found in die epidermis, the outer skin layer.

The pulse delivered by the pigmented lesion laser lasts one-third of a millionth of a second, and covers an area the size of a pea. It, too, feels like a rubber band snap. Two weeks after treatment, the skin peels away and is replaced from beneath with a new, unblemished epidermis.