Copper vapour laser (578 nm) and flashlamp-pumped pulsed tunable dye laser (585 nm) treatment of port wine stains: results of a comparative study using test sites.

The copper vapour laser (CVL), emitting at 578 nm, has recently become available for treating vascular skin lesions. Its place in the management of port wine stains (PWS) requires clarification. We have compared a CVL with a pulsed tunable dye laser (PTDL; 585 nm) in 43 patients with macular, blanchable PWS. Test areas were performed with the CVL, using a Hexascan and an energy fluence just sufficient to produce immediate tissue change (mean fluence 18.2 J/cm2 and mean pulse width 50 ms). Test areas were performed with the PTDL using a 5-mm spot at 6.5 J/cm2. Assessments were made after 4 months, subjectively using a clinical fading score and objectively using an index of light absorbence derived from reflectance spectrophotometry. The fading produced by the PTDL was significantly better than the CVL, as determined by clinical assessment (mean fading scores 2.41 and 1.67, respectively, P < 0.0005) and reflectance spectrophotometry (mean absorbence index 149 and 157 respectively, P < 0.0005). These results indicate that the PTDL is the preferred treatment for most macular, blanchable PWS. However, in a proportion of lesions responses were equivalent with both lasers, and in a small proportion, the CVL produced a better response.