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Pulsed dye laser treatment of paediatric port wine stains-variation of practice in the UK (NHS). Lasers Med Sci 2016; 31:597. [PMID: 26861977 DOI: 10.1007/s10103-016-1890-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
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102
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Bae YSC, Ng E, Geronemus RG. Successful treatment of two pediatric port wine stains in darker skin types using 595 nm laser. Lasers Surg Med 2016; 48:339-42. [PMID: 26749116 DOI: 10.1002/lsm.22467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Port wine stain (PWS) is a congenital vascular malformation of skin involving post-capillary venules, which commonly occurs on the face. While successful treatment has been reported with Caucasian, Hispanic, and Asian skin, physicians have battled treating these progressive lesions in patients of darker skin color, as the targeted chromophore (hemoglobin) shares a similar absorption coefficient as melanin. There are no reports of favorable outcomes in African-American children or adults. Although treatment in darker skin types has been previously discouraged we present a case series of patients of African descent with port wine stains treated using a pulsed-dye laser (Vbeam Perfecta, Candela Laser,Wayland, Mass) with significant improvement and no complications. STUDY DESIGN/MATERIAL AND METHODS Presentation of two pediatric patients of African descent (skin types 4 and 5) ages 1 month and 4 years old seen and treated in our office using a pulsed-dye laser until resolution. Laser parameters were spot size 10 mm; fluence 7-8.25 J/cm2; wavelength 595 nm; pulse duration 1.5 Millisecond with dynamic cooling. RESULTS Resolution of the port wine stain without complication. CONCLUSION This early approach represents a new and safe therapeutic option for treating port wine stains in this patient population. To our knowledge, the successful use of pulsed dye laser for the treatment of port wine stain in patients of African descent without complications has not yet been reported.
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Affiliation(s)
- Yoon-Soo Cindy Bae
- Laser & Skin Surgery, Center of New York, New York, New York, 10016.,Department of Dermatology, The Ronald O. Perelman, NYU Langone Medical Center, New York, New York, 10016
| | - Elise Ng
- Department of Dermatology, The Ronald O. Perelman, NYU Langone Medical Center, New York, New York, 10016
| | - Roy G Geronemus
- Laser & Skin Surgery, Center of New York, New York, New York, 10016.,Department of Dermatology, The Ronald O. Perelman, NYU Langone Medical Center, New York, New York, 10016
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103
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Shahriari M, Makkar H, Finch J. Laser therapy in dermatology: Kids are not just little people. Clin Dermatol 2015; 33:681-6. [DOI: 10.1016/j.clindermatol.2015.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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104
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Griffin TD, Foshee JP, Finney R, Saedi N. Port wine stain treated with a combination of pulsed dye laser and topical rapamycin ointment. Lasers Surg Med 2015; 48:193-6. [DOI: 10.1002/lsm.22436] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Thomas D. Griffin
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia Philadelphia 19107
| | - James P. Foshee
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia Philadelphia 19107
| | - Robert Finney
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia Philadelphia 19107
| | - Nazanin Saedi
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia Philadelphia 19107
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105
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Assessment of the role of LASER-Doppler in the treatment of port-wine stains in infants. J Pediatr Surg 2015; 50:1388-92. [PMID: 25783407 DOI: 10.1016/j.jpedsurg.2014.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/22/2014] [Accepted: 12/24/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Port-wine stains (PWS) are malformations of capillaries in 0.3% of newborn children. The treatment of choice is by pulsed dye LASER (PDL), and requires several sessions. The efficacy of this treatment is at present evaluated on the basis of clinical inspection and of digital photographs taken throughout the treatment. LASER-Doppler imaging (LDI) is a noninvasive method of imaging the perfusion of the tissues by the microcirculatory system (capillaries). The aim of this paper is to demonstrate that LDI allows a quantitative, numerical evaluation of the efficacy of the PDL treatment of PWS. METHOD The PDL sessions were organized according to the usual scheme, every other month, from September 1, 2012, to September 30, 2013. LDI imaging was performed at the start and at the conclusion of the PDL treatment, and simultaneously on healthy skin in order to obtain reference values. The results evidenced by LDI were analyzed according to the "Wilcoxon signed-rank" test before and after each session, and in the intervals between the three PDL treatment sessions. RESULTS Our prospective study is based on 20 new children. On average, the vascularization of the PWS was reduced by 56% after three laser sessions. Compared with healthy skin, initial vascularization of PWS was 62% higher than that of healthy skin at the start of treatment, and 6% higher after three sessions. During the 2 months between two sessions, vascularization of the capillary network increased by 27%. CONCLUSION This study shows that LDI can demonstrate and measure the efficacy of PDL treatment of PWS in children. The figures obtained when measuring the results by LDI corroborate the clinical assessments and may allow us to refine, and perhaps even modify, our present use of PDL and thus improve the efficacy of the treatment.
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106
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Adamič M, Pavlović MD, Troilius Rubin A, Palmetun-Ekbäck M, Boixeda P. Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology. J Eur Acad Dermatol Venereol 2015; 29:1661-78. [PMID: 25931003 DOI: 10.1111/jdv.13177] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/07/2015] [Indexed: 12/16/2022]
Abstract
AIM Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions. METHODS These guidelines were produced by a Consensus Panel made up of experts in the field of vascular laser surgery under the auspices of the European Society of Laser Dermatology. Recommendations on the use of vascular lasers and IPLS were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. RESULTS Lasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects.
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Affiliation(s)
- M Adamič
- Dermatology Center Parmova, Ljubljana, Slovenia
| | - M D Pavlović
- Dermatology Center Parmova, Ljubljana, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - A Troilius Rubin
- Department of Dermatology, Centre for Laser and Vascular Anomalies, Skåne University Hospital, Malmö, Sweden
| | - M Palmetun-Ekbäck
- Department of Dermatology, University Hospital Örebro, Örebro, Sweden
| | - P Boixeda
- Laser Service, Department of Dermatology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain
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107
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Abstract
Port-wine stains are a type of capillary malformation affecting 0.3% to 0.5% of the population. Port-wine stains present at birth as pink to erythematous patches on the skin and/or mucosa. Without treatment, the patches typically darken with age and may eventually develop nodular thickening or associated pyogenic granuloma. Laser and light treatments provide improvement through selective destruction of vasculature. A variety of vascular-selective lasers may be employed, with the pulsed dye laser being the most common and well studied. Early treatment produces more optimal results. Advances in imaging and laser treatment technologies demonstrate potential to further improve clinical outcomes.
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Affiliation(s)
| | - Roy G Geronemus
- Laser and Skin Surgery Center of New York, New York, NY, USA
| | - Kavitha K Reddy
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
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108
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Shi W, Wang J, Lin Y, Geng J, Wang H, Gong Y, Liu H, Zhang F. Treatment of port wine stains with pulsed dye laser: a retrospective study of 848 cases in Shandong Province, People's Republic of China. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:2531-8. [PMID: 25548515 PMCID: PMC4271787 DOI: 10.2147/dddt.s71710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Currently, 595 nm pulsed dye laser (PDL) therapy is offered as one of the effective treatments of port wine stains (PWSs). However, the efficacy of PDL differs in different populations. Objective The purpose of the study was to investigate the efficacy, and related factors, of 595 nm PDL in the treatment of PWSs in Chinese patients with skin type III to IV. Methods A total of 848 cases that were treated with PDL were enrolled and analyzed in this study. An independent dermatologist evaluated these lesions according to the before and after photographs. Results The response rate (RR) of all the 848 PWS patients was 69.9%, within which the cure rate was 6.3%. The patients aged ≤1 year had the highest RR (93.9%), whereas those treated after age 50 reacted the worst (RR =25%). We analyzed the anatomical distribution of the lesion and found that the temporal region had the highest lesion clearance (RR =75.3%), while the extremities had the lowest clearance (RR =44.5%). Compared with the patients whose lesion size was larger than 80 cm2, the patients with small lesion size, of 0–20 cm2, had better clinical effect (RR =73.8% vs 53.2%). The reactions of the patients with hyperplastic lesion were worse than those with red patches (RR =36.4% vs 71.7%). As well, increasing treatment numbers could achieve higher clearance rates (P=0.005). Conclusion The PDL had a relatively high RR but a low clearance rate in Chinese patients with PWS, although the earlier the intervention, the better was the efficacy. The response of PDL was, not only related to the anatomical area, but also, to the lesion size, type of lesion (ie, the presence of existing hyperplastic lesions), and the number of treatment, all of which are essential for the evaluation of therapeutic effect and acquisition of patients consent before treatment.
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Affiliation(s)
- Wenhao Shi
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China ; Shandong Provincial Key Lab for Dermatovenereology, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China ; School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Jinliang Wang
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, People's Republic of China ; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, People's Republic of China
| | - Yan Lin
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, People's Republic of China ; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, People's Republic of China
| | - Jianhui Geng
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, People's Republic of China ; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, People's Republic of China
| | - Haixia Wang
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, People's Republic of China ; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, People's Republic of China
| | - Yueqin Gong
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, People's Republic of China ; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, People's Republic of China
| | - Huaxu Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China ; Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, People's Republic of China ; Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, People's Republic of China
| | - Furen Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China ; Shandong Provincial Key Lab for Dermatovenereology, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China ; School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China ; Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, People's Republic of China
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109
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Rosenberg TL, Richter GT. Lasers in the Treatment of Vascular Anomalies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0065-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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110
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Li ZH, Meng DS, Li YY, Lu LC, Yu CP, Zhang Q, Guan HY, Li CW, Yang X, Fu RQ. Hypericin damages the ectatic capillaries in a Roman cockscomb model and inhibits the growth of human endothelial cells more potently than hematoporphyrin does through induction of apoptosis. Photochem Photobiol 2014; 90:1368-75. [PMID: 25065502 DOI: 10.1111/php.12323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Abstract
Hypericin (HY) is a promising photosensitizer (PS) for use in photodynamic therapy (PDT). Port-wine stains (PWSs) are congenital superficial dermal capillary malformations. In this study, we evaluated the photocytotoxic effects of HY for PDT in human vascular endothelial cells and a chicken cockscomb model. HY significantly inhibited the growth of human umbilical vein endothelial cells (HUVECs), as determined by colorimetric assays and morphological observation, and flow cytometry assays indicated induction of apoptosis and collapse of the mitochondrial membrane potential. In addition, HY more effectively inhibited growth of and induced apoptosis in HUVECs compared with hematoporphyrin (HP). Further experiments performed in a Roman chicken cockscomb model also showed a clear photocytotoxic effect on the cockscomb dermal capillary upon intravenous injection of HY. This effect may be due to the role of HY in the induction of apoptosis. Transmission electron microscopical analysis showed mitochondrial morphological changes such as incomplete ridges and swelling, and immunohistochemical assays showed an increase in the release of cytochrome c. In conclusion, HY exhibited a greater photocytotoxic activity than did HP toward the growth of endothelial cells and may thus represent a potent PS for PWS PDT.
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Affiliation(s)
- Zhuo-heng Li
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
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111
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Abstract
Venous malformations are slow-flow congenital malformations. They consist of abnormal venous channels that do not involute. Venous malformations can either be superficial or involve deeper structures. Patients with venous malformations are often symptomatic. The most common complaint is pain from congestion, mass effect, or compression of neural structures. Swelling, compromise of function, and disfigurement are other common symptoms. Large lesions cause coagulopathy. Therapeutic options for the treatment of these patients include sclerotherapy, compression garments, and surgical resection. These complex patients are best treated in a multi-disciplinary clinic environment, as they require long-term follow-up throughout childhood into adulthood.
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Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Childrens Medical Center, University of Cincinnati, 3333 Burnett Ave, Cincinnati, OH 45229.
| | - Manish Patel
- Department of Radiology, Cincinnati Childrens Medical Center, University of Cincinnati, Cincinnati, OH
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112
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Fenot M, Maillard H, Célérier P, Maxaud A, Bénéton N. Étude observationnelle rétrospective du traitement des angiomes plans par laser colorant pulsé sous sédation : efficacité et tolérance chez 18 enfants. Ann Dermatol Venereol 2014; 141:419-28. [DOI: 10.1016/j.annder.2014.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/23/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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113
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Ren J, Qian H, Xiang L, Pan Z, Zhong L, Yan S, Gold MH. The assessment of pulsed dye laser treatment of port-wine stains with reflectance confocal microscopy. J COSMET LASER THER 2013; 16:21-5. [PMID: 24215420 DOI: 10.3109/14764172.2013.862552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is a noninvasive technique for evaluating cutaneous lesions with cellular level resolution close to conventional histopathology. The aim of this study is to observe the vascular changes in Port-wine (PWS) lesions and assess the clinical efficacy of Pulsed Dye Laser (PDL) treatment by examining vessel diameter and density with RCM. MATERIALS AND METHODS Eleven adult patients with PWS, each had four test patches carried out with different pulse durations (1.5, 3, 6, and 10 ms), respectively; fluences of 9-12 J/cm²; and a spot size of 7 mm. The PDL treatment was repeated 3-5 times at a 2-month interval. Photographs and measurements with RCM were taken before each treatment and 2 months after the last treatment. RESULTS The PDL treatment exhibited increasing clearance with reducing pulse durations. Vessel diameters and densities were significantly decreased in the same pulse-duration groups after treatment. There was significant difference between 1.5 ms pulse-duration group and other pulse-duration groups in reducing blood vessel diameter at the depth of 150 μm. CONCLUSIONS RCM can be used to assess the clinical efficacy of PDL treatment.
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Affiliation(s)
- Jie Ren
- Department of Dermatology, Huashan Hospital, Fudan University , Shanghai , P. R. China
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114
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Frigerio A, Bhama PK, Tan OT. Quantitative three-dimensional assessment of port-wine stain clearance after laser treatments. Lasers Surg Med 2013; 45:633-8. [DOI: 10.1002/lsm.22176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 01/16/2023]
Affiliation(s)
- Alice Frigerio
- Carolyn and Peter Lynch Center for Laser and Reconstructive Surgery; Harvard Medical School, Massachussets Eye and Ear Infirmary; Boston Massachusetts
| | - Prabhat K. Bhama
- Division of Facial Plastic and Reconstructive Surgery, Department of Otology and Laryngology; Harvard Medical School, Massachussets Eye and Ear Infirmary; Boston Massachusetts
| | - Oon T. Tan
- Carolyn and Peter Lynch Center for Laser and Reconstructive Surgery; Harvard Medical School, Massachussets Eye and Ear Infirmary; Boston Massachusetts
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115
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Savas JA, Ledon JA, Franca K, Chacon A, Nouri K. Pulsed dye laser-resistant port-wine stains: mechanisms of resistance and implications for treatment. Br J Dermatol 2013; 168:941-53. [PMID: 23290045 DOI: 10.1111/bjd.12204] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Port-wine stains (PWS) are among the most common congenital vascular malformations. Unlike capillary haemangiomas, these lesions do not involute spontaneously but rather become progressively more disfiguring as the patient ages. While benign in nature, the cosmetic deformity and attendant psychological and emotional distress prompt the majority of those afflicted to seek treatment. The pulsed dye laser (PDL) has long been considered the treatment of choice for these vascular lesions; however, very few patients achieve total clearance with PDL therapy and a significant number of lesions fail to respond at all. In order to address these recalcitrant cases, the mechanisms that contribute to treatment resistance must be understood and novel laser and light therapies must be employed. This review will address what is currently known about lesion-specific characteristics of PDL-resistant PWS as well as discuss current and future treatment options.
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Affiliation(s)
- J A Savas
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA.
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116
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Willard KJ, Cappel MA, Kozin SH, Abzug JM. Congenital and infantile skin lesions affecting the hand and upper extremity, part 1: vascular neoplasms and malformations. J Hand Surg Am 2013; 38:2271-83. [PMID: 23707594 DOI: 10.1016/j.jhsa.2013.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/08/2013] [Accepted: 03/09/2013] [Indexed: 02/02/2023]
Abstract
Many dermatologic conditions may be present on a newborn infant's upper extremity that can evoke concern for parents and/or primary caregivers. Although the pediatrician typically remains the first care provider, often these children are referred to specialists to diagnose and treat these lesions. Hand surgeons should be familiar with different infantile skin lesions on an upper extremity. Some lesions are best observed, whereas others require treatment with nonoperative measures, lasers, or surgical interventions. A 2-part series is presented to aid the hand surgeon in becoming familiar with these lesions. This part 1 article focuses on vascular neoplasms and malformations. Particular attention is paid to the multiple types of hemangiomas and hemangioendotheliomas, telangiectasias, angiokeratomas, as well as capillary, venous, and lymphatic malformations. Diagnostic tips and clinical photographs are provided to help differentiate among these lesions. In addition, the recommended treatment for each is discussed.
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Affiliation(s)
- Katherine J Willard
- Department of Dermatology, Mayo Clinic Florida, Jacksonville, Florida; Shriners Hospital for Children of Philadelphia, Philadelphia, Pennsylvania; and the Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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117
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Frigerio A, Bhama PK, Tan OT. Quantitative three-dimensional assessment of port-wine stain clearance after laser treatments. Lasers Surg Med 2013; 46:180-5. [PMID: 24155123 DOI: 10.1002/lsm.22193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Outcomes analysis of laser treatment for port-wine stains has been hampered by the lack of an objective measure of surface area and volume; moreover, treatment success is often gauged by clinician subjective assessment. Three-dimensional (3D) surface imaging has been applied in several medical disciplines to quantify surface changes, with promising results. We hypothesized that 3D surface imaging could be used to objectively measure changes in area and volume of port-wine stains following laser treatment. STUDY DESIGN/MATERIALS AND METHODS We performed a retrospective review of consecutive patients with port-wine stains treated over a 20-month time period. Area and volume of the lesions were measured using 3dMD photogrammetric software (3dMD, Atlanta, GA) before and after a series of sequential pulsed dye laser and/or alexandrite laser treatments. RESULTS Fifty-five patients with 59 port-wine stains were included in the study. The initial average measured area was 44.3 cm(2) ; final average measured area decreased to 36.9 cm(2) (P < 0.001). The average volume change was 1.20 cc for all PWS included in the study and 1.90 cc for lesions that received at least 5 laser treatments within the study period. CONCLUSION Three-dimensional photography demonstrated area and volume changes in patients with port-wine stains after laser treatments. Future studies to determine if statistically significant changes correlate with clinically appreciable changes are warranted.
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Affiliation(s)
- Alice Frigerio
- Carolyn and Peter Lynch Center for Laser and Reconstructive Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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118
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Hanke CW, Moy RL, Roenigk RK, Roenigk HH, Spencer JM, Tierney EP, Bartus CL, Bernstein RM, Brown MD, Busso M, Carruthers A, Carruthers J, Ibrahimi OA, Kauvar ANB, Kent KM, Krueger N, Landau M, Leonard AL, Mandy SH, Rohrer TE, Sadick NS, Wiest LG. Current status of surgery in dermatology. J Am Acad Dermatol 2013; 69:972-1001. [PMID: 24099730 DOI: 10.1016/j.jaad.2013.04.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 02/08/2023]
Abstract
An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.
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119
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Laquer VT, Hevezi PA, Albrecht H, Chen TS, Zlotnik A, Kelly KM. Microarray analysis of port wine stains before and after pulsed dye laser treatment. Lasers Surg Med 2013; 45:67-75. [PMID: 23440713 DOI: 10.1002/lsm.22087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Neither the pathogenesis of port wine stain (PWS) birthmarks nor tissue effects of pulsed dye laser (PDL) treatment of these lesions is fully understood. There are few published reports utilizing gene expression analysis in human PWS skin. We aim to compare gene expression in PWS before and after PDL, using DNA microarrays that represent most, if not all, human genes to obtain comprehensive molecular profiles of PWS lesions and PDL-associated tissue effects. MATERIALS AND METHODS Five human subjects had PDL treatment of their PWS. One week later, three biopsies were taken from each subject: normal skin (N); untreated PWS (PWS); PWS post-PDL (PWS + PDL). Samples included two lower extremity lesions, two facial lesions, and one facial nodule. High-quality total RNA isolated from skin biopsies was processed and applied to Affymetrix Human gene 1.0ST microarrays for gene expression analysis. We performed a 16 pair-wise comparison identifying either up- or down-regulated genes between N versus PWS and PWS versus PWS + PDL for four of the donor samples. The PWS nodule (nPWS) was analyzed separately. RESULTS There was significant variation in gene expression profiles between individuals. By doing pair-wise comparisons between samples taken from the same donor, we were able to identify genes that may participate in the formation of PWS lesions and PDL tissue effects. Genes associated with immune, epidermal, and lipid metabolism were up-regulated in PWS skin. The nPWS exhibited more profound differences in gene expression than the rest of the samples, with significant differential expression of genes associated with angiogenesis, tumorigenesis, and inflammation. CONCLUSION In summary, gene expression profiles from N, PWS, and PWS + PDL demonstrated significant variation within samples from the same donor and between donors. By doing pair-wise comparisons between samples taken from the same donor and comparing these results between donors, we were able to identify genes that may participate in formation of PWS and PDL effects. Our preliminary results indicate changes in gene expression of angiogenesis-related genes, suggesting that dysregulation of angiogenic signals and/or components may contribute to PWS pathology.
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Affiliation(s)
- Vivian T Laquer
- Department of Dermatology, University of California, Irvine, Irvine, California, USA.
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Gao K, Huang Z, Yuan KH, Zhang B, Hu ZQ. Side-by-side comparison of photodynamic therapy and pulsed-dye laser treatment of port-wine stain birthmarks. Br J Dermatol 2013; 168:1040-6. [DOI: 10.1111/bjd.12130] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Li HT, Song XY, Yang C, Li Q, Tang D, Tian WR, Liu Y. Effect of hematoporphyrin monomethyl ether-mediated PDT on the mitochondria of canine breast cancer cells. Photodiagnosis Photodyn Ther 2013; 10:414-21. [PMID: 24284094 DOI: 10.1016/j.pdpdt.2013.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/15/2013] [Accepted: 03/17/2013] [Indexed: 11/29/2022]
Abstract
Hematoporphyrin monomethyl ether (HMME) is a promising porphyrin-related photosensitize for photodynamic therapy (PDT). There still remains unknown changes regarding the mitochondrial in canine breast cancer cells treated with HMME-PDT. The aim of this study is to investigate the effect of HMME-PDT on structure and dysfunction of mitochondrial in cancer cells. The experimental approach included an initial study on the uptake of HMME using microscopic observation of the HMME-treated cells, optimization of the PDT-induced cell death by the MTT assay. These cells were then treated with HMME and a He-Ne laser at the wavelength of 632.8 nm following our optimized condition. Examination of mitochondrial changes by observing the stained cells under light microscope, mitochjondrial membrane potential flow cytometry, measuring the Ca(2+), SOD/GSH activity, ATPase and MDA contents for the mitochondria functions. The kinetics of HMME uptake in CHMm cells was determined and its cytocolic instead of nuclear distribution was demonstrated. The dose of 16mM HMME-PDT combined with 2.8 J/cm(2) laser irradiation was had the maximal impact on cell viability. This treatment resulted in structural changes in mitochondria that were accompanied with the loss of mitochjondrial membrane potential. As a result, HMME-PDT increased mitochondrial ROS, inhibited the enzymatic activities of mitochondrial SOD and GSH-Px, abolished mitochondrial ability in the uptake and release of calcium, and decreased mitochondrial ATPase activity. The combination of these abnormalities led to accumulation of ROS in mitochondrial to high levels, which in turn contributed to HMME-PDT-induced damages of mitochondrial structure and mitochondrial dysfunction.
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Affiliation(s)
- H T Li
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, China; Department of Veterinary Clinic, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
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Szychta P, Al-Nakib K, Anderson W, Stewart K, Quaba A. Quantitative method for evaluation of aesthetic results after laser treatment for birthmarks. Lasers Med Sci 2013; 28:1567-72. [PMID: 23388877 PMCID: PMC3824844 DOI: 10.1007/s10103-013-1272-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 01/22/2013] [Indexed: 11/24/2022]
Abstract
Subjective assessment of results after laser treatment for birthmarks does not provide a validated method for clinicians. Previous reports concerning objective evaluation using L*a*b color coordinates were only partially successful due to difficulties in standardizing and comparing colors from pre- and posttreatment photographs. The study aimed to present a reliable and clinically applicable method of aesthetic result assessment after laser treatment for birthmarks. All 48 patients, included in the study, were treated for birthmarks on the face or neck using laser. Each pre- and posttreatment photograph was subjected to triple objective comparative assessment of color fading with use of a computer program, as well as to subjective evaluation by three core physicians and three laypeople. Objective analysis was based on an innovative method using combined L*a*b and hue saturation value color coordinates. Accuracy was higher between objective assessment with the computer program and subjective evaluation by core physicians than by laypeople. Repeatability of results was higher with the use of the computer program than among core physicians or among laypeople. In conclusion, our method may be considered for objective assessment of the results after laser treatment of vascular and pigmented birthmarks.
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Affiliation(s)
- Pawel Szychta
- Plastic and Reconstructive Surgery Department, St John's Hospital, Howden Road West, Livingston, West Lothian, EH54 6PP, UK,
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Sharif SA, Taydas E, Mazhar A, Rahimian R, Kelly KM, Choi B, Durkin AJ. Noninvasive clinical assessment of port-wine stain birthmarks using current and future optical imaging technology: a review. Br J Dermatol 2012; 167:1215-23. [PMID: 22804872 PMCID: PMC3508172 DOI: 10.1111/j.1365-2133.2012.11139.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Port-wine stain (PWS) birthmarks are one class of benign congenital vascular malformation. Laser therapy is the most successful treatment modality of PWS. Unfortunately, this approach has limited efficacy, with only 10% of patients experiencing complete blanching of the PWS. To address this problem, several research groups have developed technologies and methods designed to study treatment outcome and improve treatment efficacy. This article reviews seven optical imaging techniques currently in use or under development to assess treatment efficacy, focusing on: reflectance spectrophotometers/tristimulus colorimeters; laser Doppler flowmetry and laser Doppler imaging; cross-polarized diffuse reflectance colour imaging system; reflectance confocal microscopy; optical coherence tomography; spatial frequency domain imaging; and laser speckle imaging.
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Affiliation(s)
- S A Sharif
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, USA.
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van Drooge AM, Bosveld B, van der Veen JPW, de Rie MA, Wolkerstorfer A. Long-pulsed 1064 nm Nd:YAG laser improves hypertrophic port-wine stains. J Eur Acad Dermatol Venereol 2012; 27:1381-6. [PMID: 23094931 DOI: 10.1111/jdv.12021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hypertrophic port-wine stains (PWS) usually respond poorly to pulsed dye laser treatment. The long-pulsed 1064 nm Nd:YAG laser can target deeper situated vessels and may therefore be more effective. OBJECTIVE To evaluate the efficacy and safety of the Nd:YAG laser for the treatment of hypertrophic PWS. METHODS In a retrospective cohort study, all hypertrophic PWS patients treated with the Nd:YAG laser between 2005 and 2011 were invited for follow-up. Clinical improvement was assessed using Physician Global Assessment (PhGA) and Patient Global Assessment (PGA). RESULTS Assessment was obtained in 32 of 44 eligible patients (mean age 51.4 years), after a mean of 2.8 (SD ± 2.1) Nd:YAG laser treatments. Good or excellent improvement of hypertrophy was found in a majority of patients, both by PhGA (91%) and PGA (93%). Good or excellent improvement of colour was found in 63% of patients by PhGA, and in 87% by PGA. Recurrence of hypertrophy was seen in three patients. All but two patients would recommend Nd:YAG treatment to other patients. Mild to moderate scars were seen in seven patients, hypopigmentation in 14 patients. CONCLUSION The 1064 nm Nd:YAG laser is highly effective in the treatment of hypertrophic PWS with only a few treatments needed. Mostly mild side effects were seen in half of all patients. Hypertrophy seems to respond better than colour. To further improve colour, a combination with pulsed dye laser treatment is advisory. Observation of immediate clinical endpoints is important when using the Nd:YAG laser, to optimize outcomes and reduce side effects.
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Affiliation(s)
- A M van Drooge
- Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of AmsterdamDepartment of Dermatology, Academic Medical Center, University of AmsterdamThe Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, The Netherlands
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França K, Chacon A, Ledon J, Savas J, Izakovic J, Nouri K. Lasers for cutaneous congenital vascular lesions: a comprehensive overview and update. Lasers Med Sci 2012; 28:1197-204. [DOI: 10.1007/s10103-012-1220-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/15/2012] [Indexed: 12/20/2022]
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