As I understand Purpura is normal after pulsed dye laser treatment but my child had done grey spots instead, why? (photo)

My 5 son has a port wine stain that is treated with a pulsed dye laser at 8 jules. He went for his 3rd laser treatment yesterday and instead of all of the area treated turning purplish (like with the previous treatments) he has some specific spots that are grayish which has not happened with any of the other laser treatments. Why the difference? Should I be worried? What specifically causes some of the areas to turn purple, yet some of the areas right next to it to turn gray?

Doctor Answers 2

Results From Laser Treatments

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The best laser for childhood facial vascular lesions is usually the Pulsed Dye Laser.

Unfortunately, the typical skin reaction is one of "Pupura" the medical word for purple

skin bruising, as you've previously experienced.  You've probably already gotten over 

the shock of seeing you child's face look so "beaten up", but have seen the bruising disappear in 8-10 days with some fading of the birthmark (thankfully!).  Grey spots may mean a lesser reaction to the laser, as well as a greater than expected reaction.  I'm sure the doctor performing the treatment watched the reaction of the skin carefully after each pulse and adjusted the energy levels based on the response of the tissue at that time.

BUT, this is NOT a case to second guess, as blistering and deep tissue damage may lead to scarring.  So, I strongly advise you to check with the treating doctor.  Sometimes a two minute reassuring phone call can lead to a better night's sleep for everyone.  Good luck with your beautiful baby.

Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Close follow up by your specialist.

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Yes, grey spots can be seen with the PDL, and they heal up in time. The important thing is follow up- especially if the skin peels or blisters develop. Possibly a review the next day by your Specialist is the correct thing to do. 


Dr Davin Lim 
Laser Dermatologist. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.