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Journal of Cosmetic Dermatology Jul 2021Port-wine stain (PWS) is a benign capillary malformation that most commonly occurs in the head and neck. It is present at birth and progresses over time. It is formed by... (Review)
Review
Port-wine stain (PWS) is a benign capillary malformation that most commonly occurs in the head and neck. It is present at birth and progresses over time. It is formed by progressive dilatation of post-capillary venules and is associated with hypertrophy and nodularity with increasing age, leading to cosmetic disfigurement and psychological aggravation. It is caused by genetic mosaicism in GNAQ and GNA11 genes. Histopathology is the gold standard for assessment of PWS but it is invasive and may cause scarring. Inadequate characterization of the lesions may predispose to inadequate treatment protocols as well as higher treatment dosages. Clinical evaluation of treatment efficacy is subjective and may not be a representative of actual results. Therefore, an objective visualization modality is required. With evolving technology, numerous optical instruments have been developed for objective evaluation and visualization of subsurface structures. These include VISIA-CR™ system, videodermoscopy, high-frequency ultrasound (HFUS), laser speckle contrast imaging (LSCI), reflectance spectrophotometers and tristimulus colorimeter, laser Doppler flowmetry (LDF), cross-polarized diffuse reflectance imaging system (CDR), reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and spatial frequency domain imaging (SFDI). These semi-quantitative modes of diagnosis are complementary to each other. Some can be used in the clinical setting while others, due to high instrument cost, are limited to the research settings. In this review, we bring to you a brief overview of noninvasive diagnostic modalities in PWS.
Topics: Hemangioma, Capillary; Humans; Infant, Newborn; Microscopy, Confocal; Port-Wine Stain; Treatment Outcome; Vascular Malformations
PubMed: 33788368
DOI: 10.1111/jocd.14087 -
Journal of Drugs in Dermatology : JDD Jun 2022We read with great interest the recent publication by Fölster-Holst et al1 in the May issue of Journal of Drugs in Dermatology, which offered a brief update on the...
We read with great interest the recent publication by Fölster-Holst et al1 in the May issue of Journal of Drugs in Dermatology, which offered a brief update on the treatment of port-wine stains.
Topics: Humans; Port-Wine Stain
PubMed: 35674754
DOI: 10.36849/JDD.6264 -
Pediatrics in Review Sep 2022Sturge-Weber syndrome (SWS) is a neurocutaneous disorder that classically presents with a triad of vascular anomalies affecting the skin, eyes, and brain. Previously,... (Review)
Review
Sturge-Weber syndrome (SWS) is a neurocutaneous disorder that classically presents with a triad of vascular anomalies affecting the skin, eyes, and brain. Previously, the trigeminal nerve distribution of a port-wine birthmark (PWB) of the face was used to identify risk of SWS. However, recent evidence has demonstrated that PWBs are vascular, not neurologic, in embryologic origin, and facial PWBs at highest risk for the brain involvement of SWS involve the forehead location. Furthermore, a PWB involving the upper or lower eyelid carries a risk of glaucoma, which requires lifelong monitoring. The gold standard of treatment for PWB is the pulsed dye laser, which has many advantages when started as early as possible in infancy. In this review, we discuss the locations of facial PWBs at risk for neurologic and ophthalmologic complications, the differential diagnosis of facial vascular birthmarks, recommendations for patient referral(s) when needed, and the advantages of early laser therapy when desired for the PWB. We also provide additional resources for pediatricians to support patients and their families.
Topics: Brain; Glaucoma; Humans; Port-Wine Stain; Risk Assessment; Sturge-Weber Syndrome
PubMed: 36045161
DOI: 10.1542/pir.2021-005437 -
Facial Plastic Surgery : FPS Dec 2012Port-wine stains (PWSs) are capillary vascular malformations that are commonly resistant to treatment. Currently, the pulsed dye laser (PDL) is the treatment of choice.... (Review)
Review
BACKGROUND AND OBJECTIVES
Port-wine stains (PWSs) are capillary vascular malformations that are commonly resistant to treatment. Currently, the pulsed dye laser (PDL) is the treatment of choice. Multiple treatments are required and complete blanching after laser irradiation is rarely achieved. We review current therapeutic modalities for PWSs and recent developments for enhanced clearance.
STUDY DESIGN/MATERIALS AND METHODS
Relevant literature was reviewed including PDL modifications for improved efficacy, alternative laser devices for treatment-resistant PWSs, and the addition of agents to modulate the wound-healing response after laser irradiation.
RESULTS
Although PDL is the treatment of choice for PWSs, increased understanding of interactions between PWSs and PDL has led to improvements in therapeutic outcome in terms of lesion blanching.
CONCLUSIONS
Preliminary evidence of combination therapy using antiangiogenic agents after laser irradiation appears promising and could lead to the development of a new standard of care for PWSs.
Topics: Angiogenesis Inhibitors; Combined Modality Therapy; Cryotherapy; Humans; Infant; Laser Therapy; Lasers, Dye; Lasers, Solid-State; Low-Level Light Therapy; Photochemotherapy; Port-Wine Stain; Sirolimus; Wound Healing
PubMed: 23188689
DOI: 10.1055/s-0032-1329936 -
JAMA Dermatology Jan 2021Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome involving the skin, brain, and eyes. Consensus recommendations for management are lacking. (Review)
Review
IMPORTANCE
Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome involving the skin, brain, and eyes. Consensus recommendations for management are lacking.
OBJECTIVE
To consolidate the current literature with expert opinion to make recommendations that will guide treatment and referral for patients with port-wine birthmarks (PWBs).
EVIDENCE REVIEW
In this consensus statement, 12 nationally peer-recognized experts in dermatology with experience treating patients with SWS were assembled. Key topics and questions were formulated for each group and included risk stratification, optimum treatment strategies, and recommendations regarding light-based therapies. A systematic PubMed search was performed of English-language articles published between December 1, 2008, and December 1, 2018, as well as other pertinent studies identified by the expert panel. Clinical practice guidelines were recommended.
FINDINGS
Treatment of PWBs is indicated to minimize the psychosocial impact and diminish nodularity and potentially tissue hypertrophy. Better outcomes may be attained if treatments are started at an earlier age. In the US, pulsed dye laser is the standard for all PWBs regardless of the lesion size, location, or color. When performed by experienced physicians, laser treatment can be safe for patients of all ages. The choice of using general anesthesia in young patients is a complex decision that must be considered on a case-by-case basis.
CONCLUSIONS AND RELEVANCE
These recommendations are intended to help guide clinical practice and decision-making for patients with SWS and those with isolated PWBs and may improve patient outcomes.
Topics: Clinical Decision-Making; Consensus; Dermatology; Humans; Lasers, Dye; Low-Level Light Therapy; Port-Wine Stain; Practice Guidelines as Topic; Sturge-Weber Syndrome; Treatment Outcome
PubMed: 33175124
DOI: 10.1001/jamadermatol.2020.4226 -
International Journal of Dermatology Jul 2022
Topics: Carcinoma, Basal Cell; Hemangioma, Capillary; Humans; Port-Wine Stain; Skin Neoplasms
PubMed: 34628637
DOI: 10.1111/ijd.15944 -
Chinese Medical Journal Nov 2022
Topics: Humans; Port-Wine Stain; Hemangioma, Capillary
PubMed: 36583915
DOI: 10.1097/CM9.0000000000002124 -
Journal of Clinical Neuromuscular... Mar 2022
Topics: Humans; Nerve Sheath Neoplasms; Port-Wine Stain
PubMed: 35188914
DOI: 10.1097/CND.0000000000000354 -
Journal of Cosmetic Dermatology Oct 2022
Topics: Humans; Port-Wine Stain; Hemangioma, Capillary; Skin; Syndrome
PubMed: 35106900
DOI: 10.1111/jocd.14822 -
Journal of the American Academy of... Jan 2023
Topics: Humans; Port-Wine Stain; Tomography, Optical Coherence; Lasers, Dye; Laser Therapy; Hemangioma, Capillary; Pigmentation Disorders; Treatment Outcome
PubMed: 31437547
DOI: 10.1016/j.jaad.2019.08.028