Treatment of nodules associated with port wine stains with CO2 laser: case series and review of the literature.

BACKGROUND: Port wine stains (PWS) are congenital malformations of capillaries, where with progression, blood vessels become ectatic and result in disfiguring nodules. OBJECTIVE: To search the MEDLINE database and review literature on the treatment of PWS and present 2 cases of adults with PWS, complicated by hypertrophic and nodular lesions, treated successfully with CO2 laser. RESULTS: Two patients with PWS, with nodular and hypertrophic areas, were treated with CO2 laser. With the first patient, improvement of 90% or greater was noted in the 14 discrete nodules present within the PWS in a V2 distribution. At baseline, ectropion of the lower eyelid was noted which resolved completely after CO2 laser. With the second patient, improvement was noted as 90% or greater in the 40 of 51 discrete nodules present within the PWS extending across the right V1-V2 distribution. CONCLUSION: Carbon dioxide ablative laser resurfacing is safe and highly effective in the treatment of the nodular and hypertrophic components of PWS. Future treatment of PWS will likely involve a hybrid approach of utilizing nonablative lasers of varying wavelengths and pulse durations and treatment with novel laser devices, with the goal of early treatment to prevent progression of PWS to disfiguring lesions.