Dermatology Week Fall Preview
A featured keynote speaker at Dermatology Week 2022 Fall, Lisa Arkin, MD, specializes in using laser therapy to treat patients with vascular birthmarks, often called port-wine stains, and will cover the topic in her session, “Ask the Experts: Pearls for Using Laser to Treat Vascular Birthmarks,” on Wednesday, September 14. She recently joined The Dermatologist to preview this session.
The Dermatologist: Can you tell us a bit about your session?
Dr Arkin: Using laser therapy to treat vascular birthmarks is one of my passions and it is amazing to be able to use a light-based device that truly creates microsurgery in the skin. The idea behind laser therapy is that we use a device to execute our target; in the case of vascular birthmarks, the goal is to remove or ablate blood vessels without damaging the collateral tissue. So, the intention of this session is to offer some pearls and pitfalls that will help guide physicians to make the right decisions in treating patients who are affected.
The Dermatologist: What clinical pearls, challenges, and opportunities for laser treatment will be discussed during your session?
Dr Arkin: The idea of picking the right device and setting the laser appropriately so you get the best outcome has to do with 3 critical pearls around the laser itself. First, you want to make sure that the wavelength, or laser of choice, is targeted for the Chroma 4. The Chroma 4s we use in dermatology are either hemoglobin, which is blood and our target in vascular birthmarks, or melanin, which is pigment and present in hair and water. However, when we think about vascular birthmarks, blood is not all the same. It is either oxygenated, and those birthmarks tend to look red or light pink, or it is deoxygenated, which represents a birthmark that looks more blue or purple. This matters because if you are trying to get the most bang for your buck out of the choice of laser, thinking about where your patient’s birthmark lives on the spectrum and selecting a device that is targeted for the kind of blood fl ow is important. It is also important when you think about additional screening for patients who have vascular birthmarks and whether you need to do anything else, such as be concerned about their brain and spine.
The second pearl is that the laser’s pulse duration, which is how fast over what duration of time the light emits at a given fluence or power, is our most critical parameter to spare surrounding tissue. We want to get all the parameters to execute the target while thinking about the pulse duration, which is intrinsically related to the anatomic size of the vessel. It is important to think about the anatomy of the birthmark. Is it a capillary malformation in an infant made of tiny blood vessels? That warrants a very short pulse duration. Are we looking at a glomuvenous malformation, which would be bluer? That dictates a different wavelength, but also has larger vessels. If so, you are going to use a longer pulse duration. At the other end of the spectrum, a venous malformation, which harbors huge, dilated blood vessels, will need the longest pulse duration. So, you are thinking about the composition of the birthmark and then the size of the vessels themselves to precisely target your laser parameters.
The third pearl, which I think is probably the most important, is that laser therapy is not a cookbook. Knowing how to look for both therapeutic end targets and warning end points during treatment is critical for success and improving what you are treating while making sure you keep the patient safe during the whole therapy.
The Dermatologist: Are there any other thoughts you want to share with your colleagues about Dermatology Week 2022 Fall as a whole?
Dr Arkin: Dermatology Week is fantastic. You get to hear from so many cutting-edge experts within specific specialties, such as inflammatory skin disease and malignancy. It is like a potpourri of the best stuff going on in the field and all the hope for the future. It is so cool that we all get together in a virtual way to learn from one another, so I am truly excited to be a part of it.
