Treating pediatric port‐wine stains without general anesthesia

Dear Editors, Port-wine stains (PWS) are the most common congenital malformation of ectatic capillaries and postcapillary venules, causing a reddish-purplish discoloration of the skin. Gold standard of therapy is the pulsed-dye laser (PDL) treatment, which selectively targets hemoglobin, thereby destroying the capillary malformation. As a result, lesions are lightenedand theprogression to irregular anddarkened stains with a nodular surface can be prevented. In addition to the location and size of PWS, an early patient age is the major determinant of PDL treatment success, which obviously relates to the thinner skin of young children.1 It might be assumed that the amount of hemoglobin being present in the small vessels of infants might be not quite sufficient for PDL treatment, but in fact younger patients frequently showbetter response than older ones.2 Jeon et al.,3 and Chapas et al.,4 have shown that PDL treatment is effective in infants of 1 year and even 6 months of age or less, respectively. Several studies have demonstrated the psychosocial PWS impacts such as stigmatization and reduced health-related quality of life, but there is still no validated outcome measure instrument to evaluate the clinical outcome of PWS treatments.5 However, early treatment can obviously avoid psychosocial impairments in paediatric PWS patients caused by progressing disfigurements and adaptation problems towards the social environment. To this end, Jiang et al. showed that both the age of the patient and PWS classification correlated positively with the Children’s Dermatology Life Index score, indicating that children’s QoL was more affected as they got older or the color of the skin lesions darkened.6 A decisive factor in favor of early treatment is the objective of minimizing the psychosocial stress which could