Treatment of recalcitrant port-wine stains (PWS) using a combined pulsed dye laser (PDL) and radiofrequency (RF) energy device

J Am Acad Dermatol. 2017 Feb;76(2):321-326. doi: 10.1016/j.jaad.2016.03.004.


Background: Pulsed dye laser (PDL) is the treatment of choice for port-wine stains (PWS). Some PWS are recalcitrant to this modality. A number of reasons for PDL treatment resistance have been described, including inadequate heat generation.

Objective: We evaluated PDL combined with radiofrequency (RF) energy into a single device to target larger and deeper blood vessels and overcome PDL resistance.

Method: This was an open-label, prospective, single-center investigation of a novel device combining RF energy with PDL conducted to treat recalcitrant PWS. Ten patients with 11 recalcitrant PWS were enrolled. Each PWS was divided into 5 treatment areas: PDL alone, RF alone, PDL+RF, RF+PDL, and untreated control. Patients underwent a maximum of 6 treatments, scheduled 4 to 6 weeks apart with follow-up evaluation at 4 and 12 weeks after the final treatment. Colorimetry and standardized digital photography were performed at all visits. Lesional biopsy specimens were collected for selected patients.

Results: Areas treated with RF followed by PDL and PDL followed by RF showed the greatest improvement based on blinded review of digital photographs, reaching statistical significance (P value < .05) at the 12-week follow-up evaluation when compared with baseline. Adverse events, including purpura, erythema, edema, scabbing, crusting, and blistering, resolved without sequelae; a small residual scar was noted in 1 patient.

Limitations: Small sample size and short follow-up period are limitations.

Conclusion: Combined RF/PDL technology is promising for the treatment of recalcitrant PWS.

Keywords: cutaneous laser; pulsed dye laser; radiofrequency; recalcitrant port-wine stains.

MeSH terms

  • Adult
  • Combined Modality Therapy
  • Electrosurgery* / instrumentation
  • Female
  • Humans
  • Lasers, Dye / therapeutic use*
  • Male
  • Middle Aged
  • Port-Wine Stain / surgery*
  • Prospective Studies