Videomicroscopy predicts outcome in treatment of port-wine stains

The use of a flashlamp-pumped, 585-nm dye laser (Candela Laser Corp, Wayland, Mass) has proved a major advance in the treatment of port-wine stains. However, not all stains respond equally and some, which may be clinically indistinguishable, do not respond at all.1-3 To investigate this phenomenon we used transcutaneous videomicroscopy (Moritex Scopeman 503, Moritex Europe, Cambridge, England) at 200-fold magnification in 2 groups of patients with port-wine stains: 15 patients before treatment and 13 patients who had shown a poor response to previous treatment. Response to treatment was graded excellent (>75% clearing), good (50%-75% clearing), or poor (<50% clearing). Two major patterns of vascular abnormality were identified: type 1, consisting of superficial, tortuous, dilated end capillary loops (blobs) (Figure 1), and type 2, composed of dilated, ectatic vessels in the superficial horizontal vascular plexus (rings) (Figure 2andFigure 3). In some patients both types were present, although type