Port-wine birthmarks (PWBs) are progressive vascular malformations with significant disfigurement and psychosocial morbidity; early light-based treatment has shown improved outcomes in the pediatric population. Somatic mosaic mutations underly the progressive nature of PWBs and explain the significant differences in response and heterogeneity of vessel architecture in the pediatric population when compared to the adult cohort. Here, we summarize a review of pediatric specific literature on the various light-based treatment modalities, including pulsed dye laser, near-infrared lasers, and intense pulsed light, providing the various indications, tips, advantages, and disadvantages for the pediatric dermatologist.

Adjuvant laser therapy of vascular anomalies is based on the principle of selective photo-thermolysis, through targeted destruction of selected chromophores with minimal injury to surrounding tissue. Choice of laser wavelength, treatment parameters, and predicted response to therapy are dependent on the dominant chromophore within the vascular anomaly, lesional location, and target depth, with relatively superficial and mucosal lesions producing the best response to therapy. Lasers can be safely combined with multi-modal approaches for vascular anomalies, including sclerotherapy, surgical excision, and systemic therapy. In this manuscript, we review the laser literature on a range of vascular anomalies, and provide indications, appropriate therapeutic and warning endpoints in the skin, pearls/pitfalls, and multi-disciplinary approaches for pediatric dermatologists pursuing laser as adjuvant therapy for vascular anomalies.

Background

The incidence of systemic lupus in children with discoid lupus is unknown.

Objective

This study assessed the baseline characteristics of patients with pediatric discoid lupus erythematosus (pDLE).

Methods

Medical records at 17 sites were reviewed for pediatric dermatology and rheumatology patients with discoid lupus erythematosus. The inclusion criteria were clinical and/or histopathologic diagnosis of discoid lupus erythematosus with an age at onset of <18 years. Baseline data were collected at the first documented visit. Outcomes included diagnosis of systemic lupus erythematosus (SLE) at the baseline visit using the 1997 American College of Rheumatology (primary) and the 2012 Systemic Lupus International Collaborating Clinics (secondary) criteria.

Results

Of the >1500 charts reviewed, 438 patients met the inclusion criteria. The cohort was predominantly female (72%) and racially/ethnically diverse. A diagnosis of SLE at the baseline visit (pDLE + SLE) was rendered in 162 (37%) patients using the American College of Rheumatology and in 181 (41%) patients using the Systemic Lupus International Collaborating Clinics criteria. Patients with pDLE + SLE were older at the time of rash onset (median, 12.9 vs 8.9 years; P < .001), with shorter time from discoid lupus erythematosus onset to diagnosis, compared with patients with pDLE-only (median, 2 vs 7 months; P < .001). Patients with pDLE + SLE were more likely to be female (P = .004), with generalized discoid lupus erythematosus and clinically aggressive disease, including end-organ involvement, positive serologies, and higher- titer levels of antinuclear antibodies (P < .001).

Limitations

Retrospective study.

Conclusion

A diagnosis of discoid lupus erythematosus in adolescence should prompt thorough screening for SLE.