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Objective:To determine the efficacy and adverse reaction of long pulse YAG 1064nm PDL in the treatment of resistant PWS.Methods:Twenty PWS patients, who were previously found to be resistant to 595nm PDL treatments, were treated three to six times with long pulse 1064nm YAG laser, with parameters as follows according to color of lesion and age of patient: energy density 65~95J/ cm2, pulse width10~20ms, light spot 5 or 7mm.The clinical efficacy and adverse reaction were evaluated through follow-up, 6 months after the last treatment.Results :2 cases obtained full recovery,3 cases obtained excellent improvement, 3 cases obtained good improvement, 4 cases obtained fair improvement, and 8 cases obtained poor improvement in all 20 PWS patients.3 patients emerged with superficial atrophic scar,2 patients emerged with hypopigmentation, 3 patients emerged with pigmentation in the treated lesions by follow-up, 6 months after the last treatment.It was higher on adverse reaction development than 595nm PDL.Conclusions :The long variable pulse-duration high energy PDL can notably improve refractory PWS treated with 595nm PDL.However, it was not more safe compare with 595nm PDL because of its higher adverse reactions.