Seeing the Light: Laser Treatment Enables a
Better Quality of Life for Dermatology Patients
Susan Okerstrom (Note)
Return to The Lions Laser Centre Homepage or DermWeb
Introduction (Return to
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 todays 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.
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 dont 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
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 didnt make sense that the technology was
available to help these people, but we couldnt
provide them with the services they needed in their own
province," states Scott Mears, Chairman of the Board
of the BC Lions Society.
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.
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
wouldnt 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.
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
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.
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.
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,
Ill be less self conscious and more
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 wasnt 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 wasnt 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 hadnt 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
shouldnt 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 didnt work effectively.
Now, lasers can be used to remove unwanted skin
pigmentation, like the pink-red colour in port wine
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
lasers 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
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
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.
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.
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.
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. "Its a bit of a drag to
have to take the ferry over every time," she says.
"But it is definitely worth it!"
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 its pretty neat that
Im 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.
to six sessions are usually enough to rid a child of his
or her port wine stain because it hasnt 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.
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 isnt
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.
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."
tattoo removal service isnt 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.
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 its
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
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
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
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
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 were at the
point where the possibilities with lasers are huge.
Were 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 well 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
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
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 dont 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
like Kate and Rebecca, who havent 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. Its nice to
know I dont have to live with this purple mark on
my face anymore. Ive had it for long enough, and
now Im ready to try life without it."
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
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.
Top (Original text appeared in Vancouver Hospital's Lifeline 8(1), Spring 1993.)