ASLMS and the Vascular Birthmark Foundation Joint Project
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When a laser is purchased to treat vascular anomalies, a lack of guidelines has resulted in inconsistent settings and extremely varied outcomes. Settings vary based on skin type, vascular anomaly type, and condition of the anomaly. By creating awareness and supporting providers with these guidelines, all patients, especially some of our youngest patients, can be protected from treatments that result in poor or damaging outcomes.
To address this, ASLMS has worked with the Vascular Birthmark Foundation to create a consensus of uniform guidelines for treating vascular birthmarks with laser therapy. By partnering with organizations like the Vascular Birthmark Foundation, ASLMS helps its members offer treatments to those in need.
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ASLMS-VBF Laser Booklet for Patients/Medical Students
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Consensus 1: It is advisable that the laser treatment of a cutaneous vascular birthmark be initiated as soon as it has been deemed safe to proceed.
Consensus 2: It is advisable that diagnosis of cutaneous vascular birthmarks be based upon presentation during the neonatal period. (Abbreviated)
Consensus 3: It is advisable that if there is uncertainty as to the type of lesion, further studies and routine examinations should be made until diagnosis can be confirmed.
Consensus 4: It is advisable that if a vascular birthmark has been ulcerated, burned, or damaged from a laser treatment, allow time for tissue to heal before resuming treatment. (Abbreviated)
Consensus 5: Some lesions thicker than 4mm may not respond to typical pulse dye laser but may respond to other lasers and/or other medical or surgical modalities, such as the Nd:YAG. (Abbreviated)
Consensus 5: Some lesions thicker than 4mm may not respond to typical pulse dye laser but may respond to other lasers and/or other medical or surgical modalities, such as the Nd:YAG. (Abbreviated)
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Treatment of hypertrophic and resistant port wine stains with a 755 nm laser: a case series of 20 patients.
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Consensus 6: It is advisable that cutaneous lesions with a pronounced bruit or reported to have a “pulse” should be investigated to rule out high flow lesions.
Consensus 7: As of 2022, the Pulsed Dye Laser is considered the gold standard for treating vascular birthmarks.
Treatment of port-wine stains with a short pulse width 532-nm Nd:YAG laser.
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Split lesion randomized comparative study between long pulsed Nd:YAG laser 532 and 1,064 nm in treatment of facial port-wine stain.
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Pulsed dye laser vs. intense pulsed light for port-wine stains: a randomized side-by-side trial with blinded response evaluation.
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Laser and IPL treatment of port-wine stains: therapy options, limitations, and practical aspects
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Split-face comparison of intense pulsed light with short- and long-pulsed dye lasers for the treatment of port-wine stains.
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Consensus 8: It is advisable that patients with a vascular birthmark around the temple, forehead, orbit, and eyelids should be referred for evaluation of Sturge Weber Syndrome (SWS). (Abbreviated)
Consensus 8: It is advisable that patients with a vascular birthmark around the temple, forehead, orbit, and eyelids should be referred for evaluation of Sturge Weber Syndrome (SWS). (Abbreviated)
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Genetic testing in the evaluation of individuals with clinical diagnosis of atypical Sturge–Weber syndrome Yeom et al: Am J Med Genet A. 2023 Jan 29.doi: 10.1002/ajmg.a.63106.
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Consensus 9: It is advisable that any patient that has a vascular birthmark around the eyelid area should be lasered after metal eye shields have been properly inserted.
Consensus 10: It is advisable that patients with a vascular birthmark on the extremities, or torso, which presents with a discrepancy in size from the opposite, non-birthmarked side, should be referred for imaging ... (Abbreviated)
Consensus 10: It is advisable that patients with a vascular birthmark on the extremities, or torso, which presents with a discrepancy in size from the opposite, non-birthmarked side, should be referred for imaging ... (Abbreviated)
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Consensus 11: It is advisable that patients with a marbling appearance of a vascular birthmark should be investigated for CMTC (Cutis Marmorata Telangiectatica Congenita). (Abbreviated)
Consensus 12: It is advisable that patients who present with dental asymmetry, when a stain is present on the gums, should be referred for imaging and for a dental exam.
Consensus 13: It is advisable that after modulating settings, and even after trying various devices, if there is no subsequent improvement in 3 consecutive treatments, ... (Abbreviated)
Consensus 13: It is advisable that after modulating settings, and even after trying various devices, if there is no subsequent improvement in 3 consecutive treatments, ... (Abbreviated)
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Consensus 14: Maximum clearance is a subjective term that needs to be mutually agreed upon between the clinician and the patient and/or caregiver. (Abbreviated)
Consensus 14: Maximum clearance is a subjective term that needs to be mutually agreed upon between the clinician and the patient and/or caregiver. (Abbreviated)
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Consensus 15: It is advisable that the Fitzpatrick Skin Type Scale should be considered, as well as skin thickness and birthmark density, to determine laser settings and selection.
Consensus 16: It is advisable that the pros and cons of general anesthesia versus other anesthesia/non anesthesia pain management options should be discussed with patient and a mutually agreed upon decision reached between clinician and patient.
FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women
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Anesthesia and Developing Brains — Implications of the FDA Warning
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Consensus 17: There is no sure way to determine if a flat red macule is a port wine stain or an infantile hemangioma since both can appear flat and blanch. (Abbreviated)
Consensus 18: Large segmental early emerging infantile hemangiomas can be treated with a laser. (Abbreviated)
Consensus 18: Large segmental early emerging infantile hemangiomas can be treated with a laser. (Abbreviated)
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Consensus 19: It is optional, but it is often helpful, for the birthmark to be outlined prior to lasering. Whatever pen is used to outline the birthmark, it should be investigated to insure there are no flammable ingredients.
Consensus 20: It is advisable that non-pharmacologic agents and analgesics should be considered as alternatives to General Anesthesia (GA). (Abbreviated)
Consensus 20: It is advisable that non-pharmacologic agents and analgesics should be considered as alternatives to General Anesthesia (GA). (Abbreviated)
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Consensus 21: Pharmacologic analgesics should be explored, especially for extensive birthmark treatment in pediatrics.
Consensus 22: There are multiple approaches to lasering large segmental port wine stains. (Abbreviated)
Consensus 23: Topicals that are used in most hospitals for punctures, such as lidocaine, lidocaine with prilocaine, lidocaine with epinephrine, and tetracaine, ... (Abbreviated)
Consensus 24: It is advisable that opioids should never be used in pediatric patients being treated by laser for a vascular birthmark.
Consensus 25: It is advisable that post laser treatment instructions may include the use of ice or cool compress.
Consensus 26: Heavy emollients or barrier creams such as Aquaphor or Vaseline may be used as needed post laser procedure.
Consensus 27: It is advisable that sunscreen should always be used following all laser treatments. Wearing a hat and avoiding the sun for up to 10 weeks following treatment is recommended.
Consensus 28: While purpura is typically a desired treatment endpoint, it does not necessarily equate to clinic effectiveness, especially in newborns where there is often no purpuric response.
Consensus 29: In some instances, purpura may not be apparent. This may be due to skin pigmentation and the age of the patient.
Consensus 30: It is advisable that both pediatric and adult patients who seem to exhibit extreme anxiousness, anxiety, or nervousness before, during, and/or after treatment may be referred for psychosocial support.
Consensus 31: It is advisable that laser experts should avoid using the word “cure” for treating vascular birthmarks. Preference should be to “improve” the lesion. Hemangiomas can be cured, but a port wine stain can be improved, not cured.
Consensus 32: It is advisable that consideration for treating the gums of patients with hyper vascular gums associated with a port wine stain should be given to the laser type and the expertise of clinician. (Abbreviated)