Seeing the Light: Laser Treatment Enables a Better Quality of Life for Dermatology Patients

by Susan Okerstrom (Note)

Contents

Return to The Lions Laser Centre Homepage or DermWeb

Introduction (Return to Contents)

AS OUR SOCIETY MOVES TOWARDS the twenty-first century, many devices that seemed like the work of imaginative science fiction authors fifteen years ago are becoming today’s reality. One such invention is the medical laser. Doctors have used lasers to break apart kidney stones, and to perform both simple and complex eye surgery. And now, they can use lasers to remove birth marks and other skin pigmentation. For people with port wine stains (pink or purple birth marks) this is welcome news. Until recently, residents of B.C. have had to travel out of the province to have these removed by laser.
Approximately three in one thousand people are born with a port wine stain on some part of their body. It can vary from light pink to dark purple, and while people who are born with one don’t always suffer from medical problems associated with the mark, they often endure a lifetime of "being different." This birthmark, named for its resemblance to a type of red wine, has no known cause.
Thanks to the generosity of the B.C. Lions Society for Children with Disabilities, Vancouver General Hospital has been able to establish the Lions Laser Skin Centre to provide a service for removing port wine stains and other types of birthmarks and skin pigmentation. "If we can help someone, especially a child, by providing a way for them to have a better quality of life then we want to do everything we can to make it possible," says Bill Townsend, Executive Director of the Lions Society.

Setting the wheels in motion (Return to Contents)

APPROXIMATELY TWO YEARS AGO the B.C. Lions Society for Children With Disabilities became aware of the fact that there were people, children and adults alike, who had to leave B.C. to receive laser treatment for removing port wine stains from their skin. "It didn’t make sense that the technology was available to help these people, but we couldn’t provide them with the services they needed in their own province," states Scott Mears, Chairman of the Board of the BC Lions Society.
The Lions Society approached VGH about getting involved in developing a program to provide this much needed service. After much discussion between the Lions Society, VGH and UBC, the Lions bought the lasers and the Centre opened for its first patients last November.
The Lions Laser Skin Centre has two lasers in use, which were purchased at a cost of approximately $250,000 each. One is called a Pulsed Dye Laser (shown here) for removing marks like port wine stains, and the other is called a Ruby Laser for removing tattoos and brown or black skin pigmentation. "Given the cost of the equipment and the competing priorities in the hospital, it wouldn’t have been possible for us to purchase the lasers without the leadership and generosity of the Lions Society, " states Brad Campbell, VGH Administrative Director of Medicine who is responsible for the administration of the Centre.
The B.C. Lions Society for Children with Disabilities is a volunteer-based organization which operates to supply special services for children, and adults, which other agencies are unable to provide. It is well known for its annual Easter Seal Campaign and Christmas telethon which has the support of thousands of volunteers each year. The VGH/UBC Eye Care Centre has also benefited from its generosity.

Feeling Different (Return to Contents)

ALTHOUGH THE LIONS LASER SKIN CENTRE is equipped to treat a variety of birthmarks and provide cosmetic services as well, its primary focus is on treating people with conditions that are covered under MSP. This includes port wine stains on the head and neck.
"No matter what some people may think, we act differently toward others with obvious differences; port wine stains on the face are no exception," asserts Dr. Harvey Lui, a dermatologist and laser surgeon with the Lions Laser Skin Centre at VGH. Dr. Lui says living with a permanent and obvious discoloration of the skin can be very traumatic for people who are normal in every other way. A recent study conducted in the United States illustrates this point.
In the study, a woman was made up to look like she had a port wine stain on her face. She then went to a few different public places and pretended to have a seizure. Not one person offered to help her at any time. Next, she removed the make-up and repeated the same exercise. Without the simulated port wine stain on her face, people went out of their way to offer her assistance.

Just a Normal Person (Return to Contents)

"IT'S NOT LIKE I'VE BEEN AN OUTCAST OR ANYTHING," stresses 14-year-old Rebecca Loucks (pictured with Dr. Lui), who has a light pink port wine stain across her nose and above one eye. "I have lots of friends and a normal life. I just think that once it (the port wine stain) is gone, I’ll be less self conscious and more confident."
Rebecca is not alone in feeling this way. Kate Spanks, a 38-year-old elementary school teacher, never felt very different while she was growing up either, even though she got asked many questions about her face. Her port wine stain is quite dark and covers half of her face. "It wasn’t until I was an adult, and was in costume for a Halloween party one year that I realized people had been treating me differently," explains Kate. I was wearing a lot of make-up so my Port wine stain wasn’t noticeable. People at the party really included me in conversation, and no one looked at me differently in any way or asked any questions. That was when I realized that I hadn’t been included in things before, and had been treated differently than people without a mark on their face."

An Illuminating Process (Return to Contents)

IN THE PAST, there was little hope of removing a port wine stain, which is actually an abnormal collection of blood vessels in a place they shouldn’t be. Techniques to get rid of port wine stains like dermabrasion (where the skin is sanded away), freezing, radiation, and skin grafting were used in the past, but often caused much pain and scarring. Dr. Lui explains, "Most of these practices were abandoned many years ago because they didn’t work effectively. Now, lasers can be used to remove unwanted skin pigmentation, like the pink-red colour in port wine stains."
A laser is an extremely pure source of light, which stays in a straight line and is capable of being made very bright. The word laser is actually an acronym for Light Amplified by the Stimulated Emission of Radiation. A laser’s intensity is determined by the amount of energy that is given to it, which is decided upon by the dermatologist according to the type and size of mark being treated.
There are a variety of processes by which lasers can work on the skin. They can apply heat (photothermal process), apply pressure to rupture pigment particles (photomechanical process), or work with drugs to create a chemical reaction (photochemical process). Fibre optic cables can be used to conduct the light through the laser.

A Number of Treatments Necessary (Return to Contents)

PATIENTS ARE REFERRED TO THE LIONS LASER SKIN CENTRE AT VGH by their family doctor or dermatologist. Dr. Lui says, "A person will come in to the clinic for a consultation where we determine if laser treatment is the right course of action for them." If laser therapy is decided upon, the physician will perform treatments on small test areas first to determine how the skin reacts; each person is different. After that (usually two or three months for a port wine stain) the treatments will begin.
The Pulsed Dye Laser uses a yellow light which is easily absorbed by the red hemoglobin within the blood vessels of a port wine stain. Each treatment lasts approximately fifteen minutes and consists of quick flashes of light administered to the area through a pen-like hand piece held by the doctor. During treatment, everyone in the room wears goggles to protect their eyes from the light.
Using a photothermal process the Pulsed Dye Laser microscopically "cooks" the blood vessels within the skin. With this process, the possibility of scarring is less than one percent.
Patients come to the clinic for six to twelve sessions of treatment by the laser, until their port wine stain is removed as much as it can be (which is completely in many cases). "People have to be patient, though," cautions Dr. Lui. "Laser treatment is a process, and not an immediate cure." The entire process may take over a year to complete. As the only hospital-based laser centre in B.C., patients travel from all over the province for their treatment. Rebecca Loucks has had three treatments so far, each time making the trip from her home in Nanaimo. "It’s a bit of a drag to have to take the ferry over every time," she says. "But it is definitely worth it!"
After the first few treatments with the Pulsed Dye Laser, patients may get some slight bruising. However this fades within 10 - 14 days. Rebecca says, "My friends have seen me when I had a bit a bruising after my first treatment. They actually think it’s pretty neat that I’m getting this done."

Kids Are Patients Too (Return to Contents)

THE LIONS LASER SKIN CENTRE AT VGH treats both children and adults. Since children may feel the laser more intensely than adults, there is a cream that can be applied to numb the area being treated.
Four to six sessions are usually enough to rid a child of his or her port wine stain because it hasn’t had time to mature. "Personally, I think that the earlier you can treat a port wine stain, the better," says Dr. Lui who has successfully treated a baby who was only a few weeks old. In some cases, as people get older, the skin involved by the port wine skin begins to swell and develops elevated bumps. Sometimes they may also bleed.

Tattoo Removal An Option (Return to Contents)

A RUBY LASER WHICH EMITS PURE RED LIGHT is used to eliminate tattoos and abnormal brown or dark skin pigmentation. Since the principle of laser treatment is based on the absorption of light, however, some colours of tattoos are easier to remove than others. For example, black and blue ink clears easily because they can absorb red light well. However, a red tattoo can be more difficult to remove.
This laser mechanically shatters the pigment of the tattoo, which is dispersed through the skin and carried away by other cells. While the surface of the skin isn’t broken as a result of treatment with the Pulsed Dye Laser, there may be some pigment exiting through the surface of the skin with the Ruby Laser.
Patients who want tattoos removed by the Ruby Laser must pay for the treatment themselves. These fees, the same as those for other cosmetic services, are used to offset the costs involved with operating the equipment. States Brad Campbell, "Cosmetic services, such as tattoo removal, are a significant part of making this a viable service, enabling greater service to others who require treatment for noncosmetic reasons."
The tattoo removal service isn’t in place to make people think that tattoos are temporary. It usually takes six or more treatments to remove a tattoo, and complete removal cannot be guaranteed.
However, having a tattoo removed can be a great relief to some people. "I am so glad that this is possible," says Jill Hamelin who is in the process of having a tattoo removed from her left shoulder. "I hate wearing sleeveless tops right now, and always get asked what my tattoo says. I will be so happy when it’s gone."
There is some discomfort associated with the Ruby Laser treatment, and there may be bruising or blistering for a brief time after each treatment. However, even with this treatment there is less than a five percent chance of scarring.

Specialized Training Important (Return to Contents)

USING THE LASER MACHINES REQUIRES SKILL and a solid understanding of the principles behind it. Dr. Lui received special training in laser surgery at Harvard Medical School, training in advanced dermatologic laser therapy.
The Lions Laser Skin Centre more fully rounds out the academic program in dermatology at UBC. Since there is a very close relationship between VGH, the University of British Columbia, and the B.C. Cancer Agency, locating the Lions Laser Skin Centre within the VGH Skin Care Centre provides an ideal setting for clinical training of medical students in dermatology. The close physical proximity of these institutions adds to an already positive situation.
"In order to keep abreast of current technology and procedures, laser training should be a strong component of a dermatology program," says Dr. Lui. "We have an incredible opportunity to become the leading skin care centre in the country, and one of the top centres in North America."

Lasers for the Future (Return to Contents)

LASER TREATMENT IS POISED ON THE BRINK of exciting new challenges and opportunities in health care. Dr. Lui enthuses, "I think we’re at the point where the possibilities with lasers are huge. We’re working on some things right now in regards to targeting diseases by using drugs in combination with lasers, and down the road who knows what we’ll be able to do." Future possibilities include treating things like warts and psoriasis with lasers. There are even studies being done on using lasers to stimulate hair growth.
With the most up-to-date equipment available right now, the Lions Laser Skin Centre at VGH is well equipped to serve people for many years to come. "Our intention is to ensure that the laser equipment is kept current," says Bill Townsend. "If that means buying new machines down the road, then we will definitely explore that possibility."
For now, though, patients are comfortable with the care they are receiving and are excited about the possibilities the laser treatment offers. Dr. Lui says, "There are some people who have led really sheltered lives because of a port wine stain on their face. Some don’t even want us as doctors to really look at it. However, with the laser treatment offering them the possibility of living without a purple mark splashed across their face, many of these people are finally willing to talk about it."
Patients like Kate and Rebecca, who haven’t felt traumatized by their birthmarks but who want to live without them can now do so without fear of much pain or the possibility of scarring. "I have a lot of confidence in Dr. Lui, who is treating me," says Kate. "He lets me asks questions and really makes me feel at ease which is so important with such a new procedure. It’s nice to know I don’t have to live with this purple mark on my face anymore. I’ve had it for long enough, and now I’m ready to try life without it."
VGH is fortunate to have the opportunity to offer a laser program of this kind. VGH President and CEO Murray Martin emphasizes this by pointing out, "The persistence of the Lions, and their recognition of the invaluable service this program will provide to people with port wine stains, and other marks on the skin, is what has seen this project to fruition. They really deserve the credit for this program becoming a reality for the people of B.C."
Laser surgery is a groundbreaking form of health care service that is paving the way for the future. It combines complex technology with the ease of ambulatory care, and most importantly helps improve the quality of life for the thousands of patients who will use the service.

Return to Top (Original text appeared in Vancouver Hospital's Lifeline 8(1), Spring 1993.)