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Lasers in Surgery and Medicine Oct 2023Port wine birthmarks (PWBs) are vascular malformations affecting 0.3%-0.5% of newborns with the tendency to persist into adulthood without adequate treatment of the...
Largest comparative analysis: Novel large spot size 595 nm, high-energy, pulsed dye laser reduces number of treatments for improvement of adult and pediatric port wine birthmarks.
OBJECTIVE
Port wine birthmarks (PWBs) are vascular malformations affecting 0.3%-0.5% of newborns with the tendency to persist into adulthood without adequate treatment of the heterogenous ectatic vessels. This study compares treatment outcomes and parameters of the prior generation pulsed dye laser (PPDL) and the larger spot novel generation pulsed dye laser (NPDL) to establish whether a larger spot size laser provides greater clearance with fewer treatments.
METHODS
One hundred and sixty patients were treated with either the PPDL (80 patients) and NPDL (80 patients) with retrospective review of age, body site, laser treatment parameters, number of treatments, and improvement following laser therapy.
RESULTS
Patients treated with PPDL were older on average than patients treated with NPDL (mean 24.8 ± 19.7 vs. mean 17.1± 19.3 years, p < 0.05). The majority of lesions treated with PPDL were located on the face and neck, whereas truncal and extremity sites were more frequently treated with the NPDL. Use of NPDL was associated with a mean maximum spot size of 13.1 mm and mean maximum fluence of 7.3 J/cm with pulse durations of 0.45-3 ms, whereas use of the PPDL was associated with a mean spot size of 10.8 mm and mean maximum fluence of 8.8 J/cm with pulse durations of 0.45-6 ms. Fifty percent improvement was seen with 8.8 PPDL treatments compared to 4.3 NPDL treatments (p ≤ 0.01) with no significant difference in overall mean improvement between both devices at the chosen parameters. Multiple regression analysis showed that device type, not age or lesion location, was the only statistically significant independent variable to affect the endpoint of at least 50% improvement of the lesion.
CONCLUSIONS
Use of the larger spot NPDL is associated with achieving 50% improvement with fewer treatments.
Topics: Infant, Newborn; Humans; Child; Adult; Lasers, Dye; Treatment Outcome; Laser Therapy; Port-Wine Stain; Low-Level Light Therapy
PubMed: 37293831
DOI: 10.1002/lsm.23693 -
Journal of Cosmetic and Laser Therapy :... May 2023Port-wine stains (PWS) are frequently refractory to laser treatments. The aim of this study is to evaluate the role of treatment interval time. From 1990, 216 patients...
Port-wine stains (PWS) are frequently refractory to laser treatments. The aim of this study is to evaluate the role of treatment interval time. From 1990, 216 patients underwent Pulsed Dye Laser sessions. The laser sessions were scheduled at a minimum interval of 4 weeks to a maximum of 48 weeks. Clinical outcomes were assessed 8 weeks after the last laser session. Better results were obtained with 8 weeks interval time between therapy session, and high efficacies were also found for intervals of 4, 6 and 10 weeks. For greater interval instead, the effectiveness is significantly lower.
Topics: Humans; Lasers, Dye; Treatment Outcome; Port-Wine Stain; Laser Therapy
PubMed: 37289942
DOI: 10.1080/14764172.2023.2222946 -
Cureus May 2023A port-wine stain is a type of non-neoplastic hamartomatous malformation of capillary blood vessels, resulting from ectatic capillaries present from birth. Lobular...
A port-wine stain is a type of non-neoplastic hamartomatous malformation of capillary blood vessels, resulting from ectatic capillaries present from birth. Lobular capillary hemangioma is a form of capillary hemangioma that occurs from hamartomatous malformation of capillaries. In our report, we discuss the rare case of both port-wine stain and capillary haemangioma on the gingiva in a 22- year-old young male.
PubMed: 37284361
DOI: 10.7759/cureus.38642 -
Archives of Dermatological Research Nov 2023Port-Wine Stains are a congenital vascular malformation that affect 0.3-0.5% of newborns. It is a benign capillary malformation that commonly occurs on the head and... (Review)
Review
Port-Wine Stains are a congenital vascular malformation that affect 0.3-0.5% of newborns. It is a benign capillary malformation that commonly occurs on the head and neck. It is formed by progressive dilation of the post-capillary venules, and as the patient ages it may be associated with hypertrophy and nodularity which can lead to cosmetic disfigurement and psychological aggravation. There are many choices of treatment such as cryosurgery, cosmetic tattooing, and dermabrasion, amongst others. The treatment of choice is pulse dye laser (PDL) because it is both effective and safe to use. In darker skin types (Fitzpatrick skin types IV-VI), treatment is more difficult. Caution when treating darker skin types with PDL comes from the fact that there is an inverse correlation between vessel specificity of the PDL and skin pigmentation. In this review, we will be reviewing the literature and discussing the manuscripts that describe the treatment of PWS on patients with fitzpatrick skin type IV-VI. Authors searched the PubMed Medline in the English language from database inception through December 2022 for eligible articles. The keywords searched included "PDL," "pulse dye laser," "skin of color," "Fitzpatrick skin types IV-VI," "fitzpatrick," "pigmented skin," "Port-wine stain," "PWS", and "pulse dye laser." The articles that were included discussed PDL in the treatment of PWS in patients of skin of color. Any additional similar articles that were cited in our search were also included. Articles that were excluded did not discuss Fitzpatrick skin types IV-VI, darker skin type, or PDL. Data collected from each article included the number of participants, Fitzpatrick skin type, age, and laser parameters. There were 120 articles that were reviewed from our search and a total of nine articles met inclusion criteria with 241 patients that were considered Fitzpatrick skin type IV-VI. The patients were of a wide range of ages from 1 month to 74 years old. In our review, patients who are treated at a younger age had better results than when treated at an older age. The results show that darker skin individuals have better results when treated at a younger age compared to adults, they can experience complete resolution. Adults who were treated saw a variation of results, from improvements in the appearance to hyperpigmentation/hypopigmentation or scarring of the treated area. Patients who are Fitzpatrick skin type IV-VI are at higher risk of adverse events when treated with PDL for PWS when compared to patients of other skin types. Studies show that PDL can be beneficial for PWS in patients of skin of color; however, there are risks of hyperpigmentation, hypopigmentation, and scarring that are important to take into consideration when treating these patients. Further research is warranted to improve the understanding of PDL for PWS in patients of skin of color.
Topics: Adult; Humans; Infant, Newborn; Port-Wine Stain; Lasers, Dye; Cicatrix; Albinism, Oculocutaneous; Hyperpigmentation; Treatment Outcome
PubMed: 37253863
DOI: 10.1007/s00403-023-02640-3 -
Cureus Apr 2023Sturge-Weber syndrome (SWS) is a rare neurological disorder that is present at birth. It is characterized by a reddish-purple birthmark on the face, typically on one...
Sturge-Weber syndrome (SWS) is a rare neurological disorder that is present at birth. It is characterized by a reddish-purple birthmark on the face, typically on one side of the forehead and upper eyelid, and sometimes involving the scalp and ear. This birthmark, called a port-wine stain, is caused by an abnormal buildup of blood vessels in the skin. SWS can also cause neurological problems such as seizures, developmental delays, and problems with vision and coordination. Treatment for SWS typically includes a combination of medications to control seizures and other symptoms, as well as laser therapy or surgery to reduce the appearance of the birthmark. Additionally, physical therapy and other therapies can help improve vision and coordination. It is important to note that the symptoms and severity of SWS can vary widely from person to person, and early diagnosis and treatment can help improve outcomes.
PubMed: 37181990
DOI: 10.7759/cureus.37451 -
Pediatric Dermatology 2023Infantile hemangiomas (IHs) are the most common pediatric vascular tumors, although their genetic etiology is largely unknown. Congenital capillary malformations (CMs)...
Infantile hemangiomas (IHs) are the most common pediatric vascular tumors, although their genetic etiology is largely unknown. Congenital capillary malformations (CMs) are associated with known somatic pathogenic variants, including GNAQ, GNA11, PIK3CA, and PIK3R1. Co-occurrence of a facial CM such as port wine stain and IH is not associated with any recognized vascular anomaly syndromes and rarely reported in the literature. We describe a case of a 5-week-old female patient with a large facial CM and extensive IHs of the lower lip, airway, and orbit who presented with airway compromise and responded to propranolol therapy.
Topics: Humans; Child; Female; Infant; Hemangioma; Vascular Malformations; Capillaries; Hemangioma, Capillary; Musculoskeletal Abnormalities
PubMed: 37164359
DOI: 10.1111/pde.15340 -
Optics Express Apr 2023Port wine stain (PWS) is a congenital cutaneous capillary malformation composed of ecstatic vessels, while the microstructure of these vessels remains largely unknown....
Port wine stain (PWS) is a congenital cutaneous capillary malformation composed of ecstatic vessels, while the microstructure of these vessels remains largely unknown. Optical coherence tomography angiography (OCTA) serves as a non-invasive, label-free and high-resolution tool to visualize the 3D tissue microvasculature. However, even as the 3D vessel images of PWS become readily accessible, quantitative analysis algorithms for their organization have mainly remained limited to analysis of 2D images. Especially, 3D orientations of vasculature in PWS have not yet been resolved at a voxel-wise basis. In this study, we employed the inverse signal-to-noise ratio (iSNR)-decorrelation (D) OCTA (ID-OCTA) to acquire 3D blood vessel images in vivo from PWS patients, and used the mean-subtraction method for de-shadowing to correct the tail artifacts. We developed algorithms which mapped blood vessels in spatial-angular hyperspace in a 3D context, and obtained orientation-derived metrics including directional variance and waviness for the characterization of vessel alignment and crimping level, respectively. Combining with thickness and local density measures, our method served as a multi-parametric analysis platform which covered a variety of morphological and organizational characteristics at a voxel-wise basis. We found that blood vessels were thicker, denser and less aligned in lesion skin in contrast to normal skin (symmetrical parts of skin lesions on the cheek), and complementary insights from these metrics led to a classification accuracy of ∼90% in identifying PWS. An improvement in sensitivity of 3D analysis was validated over 2D analysis. Our imaging and analysis system provides a clear picture of the microstructure of blood vessels within PWS tissues, which leads to a better understanding of this capillary malformation disease and facilitates improvements in diagnosis and treatment of PWS.
Topics: Humans; Port-Wine Stain; Tomography, Optical Coherence; Capillaries; Angiography
PubMed: 37157245
DOI: 10.1364/OE.485619 -
Experimental Dermatology Sep 2023Hematoporphyrin monomethyl ether-photodynamic therapy (HMME-PDT) has achieved encouraging clinical outcomes in adult port-wine stain (PWS). Optimal treatment option for...
Hematoporphyrin monomethyl ether-photodynamic therapy (HMME-PDT) has achieved encouraging clinical outcomes in adult port-wine stain (PWS). Optimal treatment option for children with PWS was minimal. To compare whether the clinical effectiveness of HMME-PDT with the 5-min (fast) administration treatment regimen (FATR) was better than the 20-min (slow) administration treatment regimen (SATR) for PWS of children in vivo and in vitro. Thirty-four children with PWS were divided into two groups including FATR and SATR. The two groups received three times HMME-PDT, respectively. Treatment efficacy and safety were evaluated in vivo and in vitro. Erythema index (EI) was used to evaluate the clinical outcomes. Both FATR and SATR were effective and safe in children with PWS after HMME-PDT. There were significance differences between the two groups in reductions of EI after the second treatment (p < 0.001) and the third treatment (p < 0.001) with HMME-PDT. The serum HMME concentration reach the peak level at short time compare with SATR group. A significance increased superoxide levels were observed in FATR group compare to SATR groups in vitro (p < 0.05). Our study suggested that HMME-PDT was effective and safe for children with PWS, the therapy regimen with FATR was better in clinical efficacy than that of the SATR.
Topics: Child; Humans; East Asian People; Hemangioma, Capillary; Photochemotherapy; Photosensitizing Agents; Port-Wine Stain; Treatment Outcome
PubMed: 37157235
DOI: 10.1111/exd.14834 -
Clinical, Cosmetic and Investigational... 2023Port wine stain (PWS) is a congenital and progressive capillary malformation characterized by structural abnormalities of intradermal capillaries and postcapillary... (Review)
Review
Port wine stain (PWS) is a congenital and progressive capillary malformation characterized by structural abnormalities of intradermal capillaries and postcapillary venules. The visible manifestation is often considered a disfigurement and the accompanying social stigma often causes serious emotional and physical impact. Hematoporphyrin monomethyl ether (HMME) is a newly authorized photosensitizer for treating PWS in China. Hematoporphyrin monomethyl ether photodynamic therapy (HMME-PDT) has successfully treated thousands of Chinese patients with PWS since 2017, and HMME-PDT may be one of the most promising strategies for the treatment of PWS. However, there are few reviews published about the clinical use of HMME-PDT. So in this article, we want to briefly review the mechanism, efficacy evaluation, effectiveness and influencing factors, and the common postoperative reactions and treatment suggestions of HMME-PDT in the treatment of PWS.
PubMed: 37139084
DOI: 10.2147/CCID.S401447 -
The Application of Clinical Genetics 2023Sturge-Weber syndrome (SWS) is a congenital, sporadic, and rare neurocutaneous disorder, characterized by the presence of a facial port-wine birthmark (PWB), glaucoma,... (Review)
Review
Sturge-Weber syndrome (SWS) is a congenital, sporadic, and rare neurocutaneous disorder, characterized by the presence of a facial port-wine birthmark (PWB), glaucoma, and neurological manifestations including leptomeningeal angiomatosis and seizures. It is caused by a postzygotic, somatic, gain-of-function variant of the gene, and more recently, the gene in association with distinctive clinical features. Neuroimaging can help identify and stratify patients at risk for significant complications allowing closer follow-up; although no presymptomatic treatment has been demonstrated to be effective to date, these patients could benefit from early treatment and/or supportive interventions. Choroid plexus (CP) thickness measurements in brain magnetic resonance imaging (MRI) have a high sensitivity and specificity for early and incipient changes in SWS. In contrast, the absence of pathologic findings makes it possible to rule out associated neurological involvement and leads to periodical observation, with new imaging studies only in cases of new clinical signs/symptoms. Periodic ophthalmological examination is also recommended every 3 months during the first year and yearly afterwards to monitor for glaucoma and choroidal hemangiomas. Treatment for SWS depends on the extent and areas that are affected. These include laser surgery for PWB, anticonvulsants in the case of brain involvement, with either seizures or abnormal EEG, and medical treatment or surgery for glaucoma. Sirolimus has been used in a limited number of patients and appears to be a safe and potentially effective treatment for cutaneous and extra-cutaneous features, however controlled clinical studies have not been carried out. Better knowledge of molecular pathways will help to develop future targeted treatments.
PubMed: 37124240
DOI: 10.2147/TACG.S363685