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UC Irvine Magazine | Winter 2025

Three to five out of every 1,000 babies are born with a port-wine birthmark, a splash of red or purple on the skin somewhere on the body, mostly commonly the face. Unlike smaller, lighter birthmarks, port-wine marks can darken, thicken and develop complications such as bleeding and infections – and may be associated with other conditions like glaucoma and even seizures.

“They can also impact a person’s social interactions and psychological well-being, particularly when they cover a sizable portion of the face,” says Dr. Kristen Kelly, UC Irvine professor and chair of dermatology.

Using a pulsed dye laser, she zaps the purple-tinted blood vessels, heating them with intermittent bursts of light until the blood flow stops and the vessels break or develop clots and resolve. The targeted therapy sometimes requires as many as 30 treatments to effectively lighten a port-wine birthmark.

UC Irvine scientists have been at the forefront of addressing these signature marks for more than a decade. Dr. J. Stuart Nelson, medical director of the Beckman Laser Institute & Medical Clinic, pioneered the first cooling laser device in 1994, revolutionizing treatment for individuals with port-wine birthmarks. The cooling device protects the surface of the skin, allowing doctors to safely deliver higher doses to event the youngest patients while minimizing the possibility of complications. Depending on the size and depth of the blood vessels, many people experience dramatic benefits.

Unfortunately, the discoloration sometimes reappears. “The risk of vessels returning is lower when we start treatment during the first year of life,” says Kelly, whose patients range from infants to individuals in their 90s. To reduce recurrence, UC Irvine researchers are investigating approaches to combine lasers with medication. New medicines may need to be developed, Kelly adds.

These epidermal anomalies aren’t just a cosmetic concern. They can thicken the skin, produce nodules and, in some cases, affect the organs, including the yes or brain. “Since we don’t know which patients are going to develop progression or complications,” Kelly says, “it’s important for anyone who has a port-wine birthmark to seek car from a qualified expert.”

Author(s): Kristen Marie Kelly, MD, FAAD, Heidi Anne Duerr, MPH
Conference: American Academy of Dermatology

Expect exciting news in the treatment of port-wine birthmarks, Kristen Marie Kelly, MD, told AAD Annual Meeting attendees.

Kristen Marie Kelly, MD, FAAD, highlighted promising advancements in the treatment of vascular malformations, particularly port-wine birthmarks at the American Academy of Dermatology (AAD) Annual Meeting.¹ Although lasers have significantly improved patient outcomes, she said, some lesions remain resistant, and recurrence continues to be a challenge. However, Kelly said new research offers hope for more effective therapies.

According to Kelly, chair and professor of dermatology at the School of Medicine, University of California, Irvine, energy-based devices remain a cornerstone of treatment, but there are emerging strategies that involve combining them with targeted medications. In her talk, “What’s Next: Future Directions for the Treatment of Port Wine Birthmarks,” she explained a deeper understanding of the genetic mutations underlying vascular malformations is paving the way for innovative approaches. “Our treatments have improved, but for resistant lesions, there is hope for the future,” she said.

Recent studies have explored the potential of adjuvant therapies, including rapamycin and imiquimod, but these have produced only modest benefits, Kelly told Dermatology Times. However, ongoing aim to identify medications that more precisely target the affected pathways. Kelly said, “New drugs are being screened, and my hope is that when we find one that really targets that pathway, the combination will be very powerful.”

Kelly emphasized the importance of continued research and professional education. For those who want to be sure to stay up to date, she suggested attending conferences such as AAD Annual Meeting. The American Society for Lasers in Medicine and Surgery (ASLMS) is also a useful resource, she said, as they provide key platforms for dermatologists to stay updated on the latest advancements. “There’s a lot of research going on in terms of new potential treatments, and people should continue to watch for more exciting options,” she told Dermatology Times.

With the integration of genetic insights, novel therapeutics, and advanced laser technologies, the future of port-wine birthmark treatment is evolving and is promising, Kelly indicated. For dermatologists, she added, staying informed about these developments will be crucial in optimizing patient care and improving long-term outcomes.

For continued conference coverage, expert insights, and breaking news, subscribe to Dermatology Times eNewsletter.

Reference

1. Kelly KM. What’s Next: Future Directions for the Treatment of Port Wine Birthmarks. Presented at: the American Academy of Dermatology Annual Meeting; March 7-11; Orlando, Florida.

Click here to watch video and read full article in Dermatology Times.

By Jill Kato, UC Irvine Beall Applied Innovation

Tom Milner, former UC Irvine professor of surgery and biomedical engineering, makes revolutionizing laser medicine sound easy.

“It was a pretty smooth path. The first time we tried it, we thought, ‘Hey, this looks like it’s going to work,’” he says about his work on lasers thirty years ago.

Milner, who recently served as the director of the Beckman Laser Institute, was a vital part of the team that invented the Dynamical Cooling Device (DCD), a medical device that sprays a cooling agent onto the skin before a laser pulse to enhance effectiveness and lessen pain.

The DCD developed from an epiphany, Milner’s colleague, distinguished professor of surgery and biomedical engineering J. Stuart Nelson, had while watching a player get hit by a “stinger” during a baseball game. He noticed how after the hit, a trainer would spray a cooling agent on the player’s injury to numb the pain.

Milner’s research team was in the midst of applying for grants from the National Institutes of Health (NIH) when Nelson wondered whether a cooling agent could be used in combination with lasers to cool and numb the skin. Over dinner, Nelson discussed his idea with Milner and visiting engineer Lars Svaasand, and the three agreed the idea had legs.

After spit-balling their ideas over the weekend, Milner went out to buy a valve while Svaasand and a student went down to the local Pep Boys to purchase R-134a, a refrigerant commonly used in automotive air conditioning systems. In the lab, they connected the refrigerant to the valve and controlled the valve with a delay generator that created a pulse to trigger the spray. In a short amount of time, their first prototype was built. The result: a breakthrough device that has since treated millions of patients and shaped the future of laser medicine.

Cold Comfort

Before the invention of epidermal cooling, the effectiveness of laser treatment was limited by the laser’s intensity. The heat caused patients pain, possible scarring, and pigmentation changes in the skin. Plus, the treatment wasn’t effective on patients with darker skin tones, since melanin in the epidermis, or top layer of skin, limited the amount of light that could reach the blood vessels that physicians were trying to treat.

When Milner first arrived at UCI in 1992, he was a research fellow joining Nelson’s team. Nelson, who is also the current medical director at the Beckman Laser Institute, was trying to come up with a more effective way to treat port-wine stains, hemangiomas, and other vascular malformations.

“We understood from the physics point of view that it was a question of how to make the skin really cold in a short amount of time,” Milner says.

The team’s challenge was to find a way to protect the outer skin while allowing the laser to penetrate deeper to the blood vessels that created these vascular abnormalities. They knew they needed to cool the skin; it was just a matter of how.

Before coming up with the cooling spray idea, the team’s original plan was to bring a cooled window onto the skin before quickly removing it.

“To me, this seemed a lot harder to build than spraying a liquid on the skin with a valve. Since I was the person who had to execute the solution, I preferred the new idea,” Milner says.

A Big Step Forward

The DCD works by delivering a quick burst of a cryogen or cooling agent, onto the skin immediately before, and often after, a laser pulse. The cryogen evaporates and the laser is triggered to target blood vessels in the dermis (the thick part of the skin under the epidermis). The technology is then incorporated into a handheld laser device that is used by a physician.

Once cooling was implemented to protect the skin’s surface, higher energy levels could be used to produce greater effectiveness. The technology also expanded treatment to patients of all skin types by mitigating the blocking effects of melanin. It also reduced patient discomfort by minimizing injury to the skin.

Dermatology chair Kristen Kelly was a research fellow at the time and worked with Nelson on studies investigating the DCD’s early uses.

“The DCD greatly advanced laser skin surgery. We’re able to provide treatment to a wider range of patients. It made the treatments less uncomfortable, and it helped to increase our efficacy. It really was a big step forward,” she says.

Cool Collaborators

Creating the device turned out to be the easy part. While the physical construction of the DCD presented minimal challenges, its complexity lay in comprehending its interaction with human skin. This is where Milner and his colleagues spent most of their time. They needed to measure the temperature of the skin as it cooled and the temperature of the skin when the laser was fired. They had to ensure their measurements were mathematically predictable and confirm their theoretical understanding of its behavior.

Click here to read full article on the UC Irvine Beall Applied Innovation website.

By Gabrielle M. Grasso | Helio.com
Fact checked by Kristen Dowd

Key takeaways:

• After being named a “big nine” food allergen, sesame was found to be associated with alopecia areata in children.
• Chemical sunscreens applies near the hairline were also linked to frontal fibrosing alopecia.

MIAMI BEACH, Fla. — Atopy from food allergies to environmental factors can increase hair loss prevalence among children and adults, according to a presentation at South Beach Symposium.

“The thing that I want you to take home today is the role of allergies in immune conditions,” Natasha A. Mesinkovska, MD, PhD, vice chair of clinical research in the department of dermatology at the University of California, Irvine, said during her presentation. “What we really should be doing for both adults and kids is asking them what they are allergic to, because if you treat the allergy, you can actually prevent people’s hair from falling out.”

According to a study conducted by Sorrell and colleagues, atopy, including food allergies, is the No. 1 comorbidity in alopecia areata among adults and children. In fact, food allergies are on the rise in the U.S., with 2% to 3% of adults and 8% of children reporting a food allergy, according to a 2023 study from Bright and colleagues. While milk, fish and peanuts may be the most common food allergies, another inflammatory ingredient has been traced to hair loss — sesame.

“I had a lot of alopecia areata kids complaining of belly aches, so I ran food panels on them and 9 out of 10 tested positive for a sesame allergy,” Mesinkovska said. “I thought to myself, how did this happen and why are all these kids testing positive?”

As Healio previously reported, sesame became a major food allergen in the U.S. on Jan. 1, 2023, after former president Biden signed into law the Food Allergy Safety, Treatment, Education and Research Act in April 2021.

The law requires food manufacturers and companies handling food to avoid sesame cross contamination and provide labels on foods that did contain the allergen. However, as Healio previously reported,this law has unintended consequences.

Companies considered the new sesame cross-contamination laws “too stringent” and instead decided it would be easier to sprinkle a little bit of sesame flour into every food item and provide a label indicating the addition of sesame to bypass the cross-contamination regulations.

As a result, patients with a sesame allergy were experiencing reactions to previously safe foods, causing a surge in comorbidity prevalences like hair loss.

“I will tell you that I have had two kids that were unable to go on [Janus kinase (JAK)] inhibitors, so we had them stop eating sesame and we stopped their alopecia areata,” Mesinkovska said. “You could say, well that’s only two for two, but for them, it was life changing.”

In another case presented by Mesinkovska, a patient with alopecia areata on JAK inhibitors who was previously doing well suddenly experienced an acute flare of facial dermatitis and increased hair loss. When Mesinkovska asked what the patient thought may be causing this flare, the patient stated they were cutting olive trees in her neighborhood, and she believes she may be allergic to the olive trees.

“When she told me that I just thought, ‘yeah, yeah sure,’” Mesinkovska said sarcastically. “So, I ran an allergy panel and guess what comes up as very, very positive? Olive trees.”

According to her presentation, food allergies are not the only factors that may cause hair loss.

Frontal fibrosing alopecia, a type of hair loss that involves many signs and symptoms outside of hair loss such as hyperpigmentation, facial papules and even forehead wrinkles, can be aggravated by chemical sunscreen.

“A study in the U.K. found that people that have this condition actually tended to use year-round sunscreens,” Mesinkovska said. “Dr. Sinclair’s group in Australia also showed a patient who stopped using sunscreen and her hair came back.”

Sinclair Dermatology now advises patients with FFA to avoid applying sunscreen products to the hairline and instead wear a wide-brimmed hat or simply avoid the sun.

“I definitely stay away from chemical sunscreens and just don’t let my patients apply it, definitely not on that area,” Mesinkovska said.

The connection between allergies, inflammation and hair loss may be complicated, but Mesinkovska recommends that it should be considered when treating patients. Running serum IgE testing on patients with alopecia areata may elucidate the root cause of symptoms as it provides high specificity and a good positive predictive value.

While dermatologists are the foremost experts on skin, hair and nails, patients themselves may offer insight into what exactly is occurring in their bodies. Mesinkovska encourages dermatologists to listen to their patients’ concerns and ideas about their disease, recalling her encounter with her patient that had the olive tree allergy along with hair loss.

“Guess who was right? She was,” Mesinkovska said. “So maybe we should listen.”

References:

• Adoori N, et al. Br J Dermatol. 2016; doi: 10.1111/bjd.14535.
• Bright DM, et al. Am Fam Physician. 2023;108(2):159-165.
• Frontal Fibrosing Alopecia (FFA). https://www.sinclairdermatology.com.au/wp-content/uploads/2019/05/Brochure-Frontal-Fibrosing-Alopecia.pdf. Accessed Feb. 10, 2025.
• Sorrell J, et al. Pediatr Dermatol. 2017;doi:10.1111/pde.13238.

Sources/Disclosures

Source: Mesinkovska NA, et al. Alopecia and comorbidities 360 view. Presented at: South Beach Symposium; Feb. 6-8, 2025; Miami Beach, Florida.
Disclosures: Mesinkovska reports having financial relationships with Abbvie, Arcutis, Arena, BMS, Concert, Galderma, Kadmon, Lilly, Merz, National Alopecia Areata Foundation, Novartis, Nutrafol, Pfizer and Sun Pharma.

Click here to read full article on Healio.com.