Survey of the practices of laser users in the UK in the treatment of port wine stains.

BACKGROUND

Laser treatment for the management of port wine stains (PWS) is well established but there are some variations in practices amongst clinicians in the UK.

OBJECTIVES

To identify areas of consensus and highlight issues where sufficient variation existed to warrant further debate or clinical research using a postal questionnaire survey of clinicians carrying out laser treatments for PWS in the UK.

METHODS

A 29-item questionnaire was constructed regarding the laser treatment of PWS and was sent to 55 members of the British Skin Laser Study Group in 2000. The questions related to the usual clinical practice of the respondents and facilities available.

RESULTS

Completed questionnaires were returned from 45 clinicians (28 dermatologists, 14 plastic surgeons, two maxillofacial surgeons and one ENT surgeon) at 36 laser centres. The following areas of consensus were identified. The majority of centres used a pulsed dye laser (PDL) for the treatment of PWS, either alone or in conjunction with a KTP laser, and medical personnel assessed and treated patients. Written information and consent was obtained in 89% of centres before starting treatment. Test areas were usually performed before embarking on a full treatment by 98% of the clinicians. The majority of respondents (84%) considered 2-3 months as the optimum interval between treatments. All the clinicians were prepared to treat patients with skin types I-IV, but skin type VI was often not treated. The vast majority of laser users treated most PWS affecting the face, neck and upper limb. The majority of clinicians used local or topical anaesthesia frequently or sometimes in the treatment of PWS and 81% of the respondents used general anaesthesia, especially when treating children. When using the PDL, 91% of respondents selected an initial fluence based on experience and/or the appearance of the skin immediately after the laser pulse. Postoperatively, most clinicians advised patients to avoid the sun, avoid injury and use an emollient. Areas of variation in practice included some centres using non-medical in conjunction with medical staff to review and treat patients. The earliest age at which the clinician thought it appropriate to treat PWS varied from newborn to 8 years old; 25% of the clinicians who treat children would treat from the age of 2-3 months old and 34% would only treat patients over 1 year old. There was considerable variation in the initial fluence selected. The usual number of treatments given to each area of the PWS varied from 3 to 16.

CONCLUSIONS

This survey has demonstrated a number of areas where there appears to be a consensus of opinion about laser treatment of PWS. However, issues where there are significant variations in practice have also been identified and require further evaluation to help direct further clinical research.