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Photodiagnosis and Photodynamic Therapy Apr 2024Port-wine stain (PWS) birthmarks are congenital capillary malformations occurring in 0.3 %∼0.5 % of newborns. Hemoporfin-mediated vascular-acting photodynamic therapy... (Comparative Study)
Comparative Study
Port-wine stain (PWS) birthmarks are congenital capillary malformations occurring in 0.3 %∼0.5 % of newborns. Hemoporfin-mediated vascular-acting photodynamic therapy (Hemoporfin PDT) is an emerging option for treating PWS. This in vivo study aimed to compare laser and light-emitting diodes (LED) as light source for Hemoporfin PDT. Chicken wattles were used as the animal model. Color and histopathological changes were evaluated after combining Hemoporfin with KTP laser or LED light source of 532 nm at the same doses. Both PDT approaches could induce significant vascular injury and color bleaching. Although the use of the laser resulted in a greater vascular clearance, the LED showed more uniform distribution both in the beam profiles and tissue reaction and exhibited better safety. This in vivo study suggests that the LED is a favorable choice for larger PWS lesion.
Topics: Animals; Port-Wine Stain; Chickens; Photochemotherapy; Photosensitizing Agents; Hematoporphyrins; Lasers, Solid-State; Disease Models, Animal
PubMed: 38598961
DOI: 10.1016/j.pdpdt.2024.104068 -
Photodiagnosis and Photodynamic Therapy Apr 2024Vascular-targeted photodynamic therapy (V-PDT) is a clinically approved therapeutic approach for treating vascular-related diseases, such as port-wine stains (PWS). For...
SIGNIFICANCE
Vascular-targeted photodynamic therapy (V-PDT) is a clinically approved therapeutic approach for treating vascular-related diseases, such as port-wine stains (PWS). For accurate treatment, varying light irradiance is required for different lesions due to the irregularity of vascular size, shape and degree of disease, which commonly alters during different stages of V-PDT. This makes quantitative analysis of the treatment efficiency urgently needed.
APPROACH
Lesion images pre- and post- V-PDT treatment of patients with PWS were used to construct a quantitative method to evaluate the differences among lesions. Image analysis techniques were applied to evaluate the V-PDT efficiency for PWS by determining the Euclidean distances and two-dimensional correlation coefficients.
RESULTS
According to the image analysis, V-PDT with good treatment efficiency resulted in a larger Euclidean distance and a smaller correlation coefficient compared with the case having lower V-PDT efficiency.
CONCLUSIONS
A new method to quantify the Euclidean distances and correlation coefficients has been proposed, which is promising for the quantitative analysis of V-PDT efficiency for PWS.
Topics: Port-Wine Stain; Photochemotherapy; Humans; Photosensitizing Agents; Female; Male; Adult; Aminolevulinic Acid; Child; Adolescent
PubMed: 38588873
DOI: 10.1016/j.pdpdt.2024.104081 -
Zhonghua Bing Li Xue Za Zhi = Chinese... Apr 2024
Topics: Humans; Capillaries; Port-Wine Stain; Vascular Malformations; Cell Proliferation
PubMed: 38556824
DOI: 10.3760/cma.j.cn112151-20231023-00292 -
Lasers in Surgery and Medicine Apr 2024Port wine birthmark (PWB) is a congenital vascular malformation of the skin. Pulsed dye laser (PDL) is the "gold standard" for the treatment of PWB globally.... (Review)
Review
BACKGROUND
Port wine birthmark (PWB) is a congenital vascular malformation of the skin. Pulsed dye laser (PDL) is the "gold standard" for the treatment of PWB globally. Hematoporphyrin monomethyl ether (HMME or hemoporfin)-mediated photodynamic therapy (HMME-PDT) has emerged as the first choice for PWB treatment, particularly for young children, in many major hospitals in China during the past several decades.
AIM
To evaluate whether HMME-PDT is superior to PDL by comparing the clinical efficacies of both modalities.
METHOD
PubMed records were searched for all relevant studies of PWB treatment using PDL (1988-2023) or HMME-PDT (2007-2023). Patient characteristics and clinical efficacies were extracted. Studies with a quartile percentage clearance or similar scale were included. A mean color clearance index (CI) per study was calculated and compared among groups. An overall CI (C), with data weighted by cohort size, was used to evaluate the final efficacy for each modality.
RESULT
A total of 18 HMME-PDT studies with 3910 patients in China were eligible for inclusion in this analysis. Similarly, 40 PDL studies with 5094 patients from nine different countries were eligible for inclusion in this analysis. Over 58% of patients in the HMME-PDT studies were minors (<18 years old). A significant portion (21.3%) were young children (<3 years old). Similarly, 33.2% of patients in the PDL studies were minors. A small proportion (9.3%) was young children. The overall clearance rates for PDL were slightly, but not significantly, higher than those for HMME-PDT in cohorts with patients of all ages (C, 0.54 vs. 0.48, p = 0.733), subpopulations with only minors (C, 0.54 vs. 0.46, p = 0.714), and young children (C, 0.67 vs. 0.50, p = 0.081). Regrettably, there was a lack of long-term data on follow-up evaluations for efficacy and impact of HMME-PDT on young children in general, and central nervous system development in particular, because their blood-brain barriers have a greater permeability as compared to adults.
CONCLUSION
PDL shows overall albeit insignificantly higher clearance rates than HMME-PDT in patients of all ages; particularly statistical significance is nearly achieved in young children. Collectively, current evidence is insufficient to support HMME-PDT as the first choice of treatment of PWBs in young children given: (1) overall inferior efficacy as compared to PDL; (2) risk of off-target exposure to meningeal vasculature during the procedure; (3) administration of steriods for mitigation of side effects; -and (4) lack of long-term data on the potential impact of HMME on central nervous system development in young children.
Topics: Child; Adult; Humans; Child, Preschool; Adolescent; Photochemotherapy; Hematoporphyrins; Treatment Outcome; Port-Wine Stain; Lasers, Dye; China; Photosensitizing Agents
PubMed: 38506454
DOI: 10.1002/lsm.23779 -
BMJ Case Reports Mar 2024Klippel-Trenaunay syndrome (KTS) is a rare, congenital disorder typically emerging in early infancy or childhood. The classic presentation of KTS is distinguished by a...
Klippel-Trenaunay syndrome (KTS) is a rare, congenital disorder typically emerging in early infancy or childhood. The classic presentation of KTS is distinguished by a triad of clinical features: a port-wine stain, early-onset varicosities and limb overgrowth. However, a notable variant of KTS has been documented, characterised by limb shortening rather than lengthening, occasionally referred to as 'inverse KTS'. This report details two cases that display this unusual presentation-both patients had classical features of port-wine stain and varicose veins but both experienced shortening of the affected limb. Whether these cases represent a variant of KTS or a new clinical syndrome altogether is uncertain. They however offer valuable insights into the nuances and breadth of clinical manifestations associated with this syndrome.
Topics: Humans; Extremities; Hemangioma, Capillary; Klippel-Trenaunay-Weber Syndrome; Port-Wine Stain; Rare Diseases; Varicose Veins
PubMed: 38471707
DOI: 10.1136/bcr-2024-259763 -
The Australasian Journal of Dermatology May 2024
Topics: Humans; Dermoscopy; Port-Wine Stain; Female; Male; Child; Face; Adult; Adolescent; Treatment Outcome
PubMed: 38439556
DOI: 10.1111/ajd.14226 -
Photodiagnosis and Photodynamic Therapy Apr 2024Two cases of acquired port-wine stain (APWS) at lower extremity were treated with hematoporphyrin monomethyl ether (HMME) and 532 nm LED green light-mediated...
Two cases of acquired port-wine stain (APWS) at lower extremity were treated with hematoporphyrin monomethyl ether (HMME) and 532 nm LED green light-mediated photodynamic therapy (HMME-PDT). No serious adverse reactions were observed during or post-treatment period. Five-month follow-up showed significant reduction of red patches after a single HMME-PDT treatment in both cases.
Topics: Hematoporphyrins; Humans; Photochemotherapy; Port-Wine Stain; Photosensitizing Agents; Male; Female; Adult; Lower Extremity
PubMed: 38431025
DOI: 10.1016/j.pdpdt.2024.104032 -
Photodiagnosis and Photodynamic Therapy Apr 2024Portwine stain (PWS) birthmarks are congenital vascular malformations. The quantification of PWS area is an important step in lesion classification and treatment...
BACKGROUND
Portwine stain (PWS) birthmarks are congenital vascular malformations. The quantification of PWS area is an important step in lesion classification and treatment evaluation.
AIMS
The aim of this study was to evaluate the combination of 3D scan with deep learning for automated PWS area quantization.
MATERIALS AND METHODS
PWS color was measured using a portable spectrophotometer. PWS patches (29.26-45.82 cm) of different color and shape were generated for 2D and 3D PWS model. 3D images were acquired by a handheld 3D scanner to create texture maps. For semantic segmentation, an improved DeepLabV3+ network was developed for PWS lesion extraction from texture mapping of 3D images. In order to achieve accurate extraction of lesion regions, the convolutional block attention module (CBAM) and DENSE were introduced and the network was trained under Ranger optimizer. The performance of different backbone networks for PWS lesion extraction were also compared.
RESULTS
IDeepLabV3+ (Xception) showed the best results in PWS lesion extraction and area quantification. Its mean Intersection over Union (MIou) was 0.9797, Mean Pixel Accuracy (MPA) 0.9908, Accuracy 0.9989, Recall 0.9886 and F1-score 0.9897, respectively. In PWS area quantization, the mean value of the area error rate of this scheme was 2.61 ± 2.33.
CONCLUSIONS
The new 3D method developed in this study was able to achieve accurate quantification of PWS lesion area and has potentials for clinical applications.
Topics: Humans; Deep Learning; Imaging, Three-Dimensional; Port-Wine Stain; Face; Spectrophotometry
PubMed: 38423233
DOI: 10.1016/j.pdpdt.2024.104030 -
Journal of Cosmetic Dermatology Jun 2024
Topics: Humans; Photochemotherapy; Glycyrrhizic Acid; Port-Wine Stain; Bandages; Female; Photosensitizing Agents; Skin; Aminolevulinic Acid; Adult
PubMed: 38410871
DOI: 10.1111/jocd.16250 -
Journal of Cosmetic Dermatology Jun 2024Klippel-Trenaunay-Weber syndrome (KTWS) is a rare disease with a wide range of manifestations. KTWS is characterized by a clinical triad of varicosities of the...
BACKGROUND
Klippel-Trenaunay-Weber syndrome (KTWS) is a rare disease with a wide range of manifestations. KTWS is characterized by a clinical triad of varicosities of the extremities, cutaneous vascular malformations, and hypertrophy of soft tissues and long bones. The diagnosis is made clinically supplemented with magnetic resonance imaging and computed tomography.
AIM
Hereby we aim to highlight the significance of the possible life-threatening first-time presentations associated with the GI system in previously undiagnosed KTWS patients.
PATIENT
We report the case of a 47-year-old male with KTWS, who presented with various symptoms such as rectorrhagia since childhood, digestive problems and abnormal lateral vascular malformations of the left buttock which extended all the way to the leg, vascular malformations of the left fourth and fifth toes as well as soft tissue swelling of the left foot. There was no evidence of other clinical presentations. The patient was hospitalized with severe rectorrhagia and a hemoglobin level of 3/9. Physical examination revealed a blood pressure of 85/55 and pulse rate of 115. Ruptured aneurysm of the superior mesenteric artery was found on angiography and subsequently treated with embolization. Dermatologic evaluation showed pitting edema of the left leg and foot and multiple vascular lesions. Thus a diagnosis of KTWS was established. Pulsed dye laser therapy and compression bandage was performed for the patient. The patient's follow-up was done 3 months after discharge for which the patient was again consulted by a dermatologist and gastroenterologist. Lymphedema of the left leg had improved to a great extend so treatment with compression bandage was continued. Colonoscopy was repeated for the patient to evaluate and control possible active sources of bleeding, due to potential life-threating complications.
RESULTS
According to previous findings, there have been few case reports of KTWS presenting with gastrointestinal manifestations, fewer of which have covered acute life-threatening bleedings associated with this system.
Topics: Humans; Klippel-Trenaunay-Weber Syndrome; Male; Middle Aged; Rare Diseases; Vascular Malformations
PubMed: 38389293
DOI: 10.1111/jocd.16247