Pulse-Dye Laser Without General Anesthesia is Well Tolerated by Infants and Toddlers

A novel study characterizes short-term pain and documents tolerance of office-based Pulse-dye laser (PDL) treatments for port wine birthmark in an age group that cannot verbalize their treatment experience.

Outpatient pulsed-dye laser treatment of port wine birthmarks without general anesthesia was well tolerated in infants and toddlers, with most patients recovering from treatment-associated pain within 5 minutes of the procedure, according to findings from a study published in the Journal of the American Academy of Dermatology.

This prospective study included children younger than 2 years of age who underwent outpatient port wine birthmark treatment with pulse-dye laser therapy without general anesthesia. Also, patients did not receive any pretreatment topical or systemic analgesics. Investigators evaluated peri- and post-procedure pain in the clinic and at home using the Evaluation Enfant Douleur (EVENDOL) pain scale and Parents’ Postoperative Pain Measure (PPPM), respectively.

Non-pharmacologic measures were used to comfort patients following the procedure. These measures included breastfeeding, skin-to-skin contact, and providing a pacifier or sucrose solution to the child.

At time of the study, the mean age of patients was 10.55 months, and the mean age of the children at the first pulsed-dye laser treatment was 3.26 months. Children were predominantly Hispanic White (59.57%), and the majority of patients had a port wine birthmark on their face (61.70%).

Immediately after treatment, the mean EVENDOL pain score rose significantly to 9.09±3.82 but returned to baseline by the time patients left the clinic (0.89±1.49). The investigators concluded that most patients in the observational study recovered from the pain within 5 minutes after treatment. In addition, more than 93% of children did not meet a clinically significant pain threshold by the time they left the office.

Based on mean PPPM scores, parents perceived that their children experienced minimal and decreasing pain at home on days 0 (1.83), 3 (0.74), and 7 (0.40).

The study’s limitations were the lack of a control or comparison group as well as the limited follow-up period, which the investigators suggest reduced their ability to identify any long-term psychological effects associated with laser therapy in these children.

The researchers noted that children in their study “began recalling treatments at a mean age of 12 months, emphasizing the importance of early and frequent treatment to maximize efficacy and minimize undesirable outcomes.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Feng H, Materne G, Ghalili S, et al. Assessment of treatment tolerance and parental perspective of outpatient pulsed-dye laser treatment for port-wine birthmark without general anesthesia in infants and toddlers. Published online September 30, 2020. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.09.056