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Zhang H, Bian Y, Yin W, Li D, Ying Z. A feasible way to explore real blood vessels thermal responses to laser irradiation by combing optical clearing and the reflectance spectra measurements: animal experiment study. Lasers Med Sci 2024; 39:193. [PMID: 39052099 DOI: 10.1007/s10103-024-04142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
Laser therapy has been widely used to treat port-wine stains (PWS) and other cutaneous vascular lesions via selective photothermolysis. Animal models are a valuable tool for investigating thermal responses beneath the skin. However, in previous animal experiments, such as the dorsal skin chamber model, one side of the skin was removed, resulting in the loss of mechanical support for the target blood vessel. In this study, the optical clearing technique was applied to the dorsal skin, allowing direct observation of real thermal responses within the tissue without removing the covering skin. The target blood vessels were irradiated with a pulsed 1064 nm Nd: YAG laser. The corresponding thermal responses were recorded using a CCD camera. Additionally, variations in skin reflectance spectra were measured before and after laser irradiation. Due to the optical clearing and reflectance spectra measurement, vessel responses such as contraction, reperfusion, and full occlusion were correlated with specific variation patterns in reflectance spectral signals.
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Affiliation(s)
- Hong Zhang
- School of Humanities and Social Science, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
- Shaanxi Provincial Institute for Skin Disease and STD Control, Xi'an, 710049, Shaanxi, China
| | - Yanjie Bian
- School of Humanities and Social Science, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Wei Yin
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Dong Li
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China.
| | - Zhaoxia Ying
- Shaanxi Provincial Institute for Skin Disease and STD Control, Xi'an, 710049, Shaanxi, China.
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2
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Elsanadi RA, Messele F, Lee J, Choi B, Kelly KM. Optical coherence tomography-measured blood vessel characteristics of port-wine birthmarks by depth: A cross-sectional study. J Am Acad Dermatol 2024:S0190-9622(24)01050-8. [PMID: 39004348 DOI: 10.1016/j.jaad.2024.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 05/12/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Port-Wine Birthmarks (PWB) are congenital capillary malformations requiring multiple treatments. Optical coherence tomography (OCT), a noninvasive imaging technique, characterizes vessels in cutaneous vascular lesions, including PWBs. OBJECTIVE To assess variability in blood vessel characteristics within and between individual PWBs. METHODS OCT was used to measure blood vessel density (%) and modal vessel diameter (micrometers) at increments of 0.05 mm from the skin surface to a depth of 0.50 mm at several adjacent spots of single PWBs in this cross-sectional study. Average ratios of vessel density and diameter in affected to control skin were obtained for each PWB by averaging data for all spots within a lesion. Statistical analysis was performed with a linear mixed effects model using SPSS software (IBM Corporation). RESULTS There was great variability in vessel density and diameter within and between PWBs. Depths where average ratios of vessel density were consistently greater in affected to control skin were shallow, between 0.15 mm and 0.2 mm deep from the skin surface. LIMITATIONS Small sample size and device's inability to measure diameters smaller than 20 micrometers. CONCLUSION There is variability in vessel density and diameter within and between PWBs. Individualized treatment planning guided by OCT mapping should be studied further.
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Affiliation(s)
- Rachel Ann Elsanadi
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Feben Messele
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Jaylen Lee
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, California
| | - Bernard Choi
- Beckman Laser Institute, University of California, Irvine, Irvine, California
| | - Kristen M Kelly
- Department of Dermatology, University of California, Irvine, Irvine, California; Beckman Laser Institute, University of California, Irvine, Irvine, California.
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3
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Park J, Shobayashi K, Kim B. Optical Microneedle-Lens Array for Selective Photothermolysis. MICROMACHINES 2024; 15:725. [PMID: 38930695 PMCID: PMC11206131 DOI: 10.3390/mi15060725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Photothermolysis is the process that converts radiation energy into thermal energy, which results in the destruction of surrounding tissues or cells through thermal diffusion. Laser therapy that is based on photothermolysis has been a widely used treatment for various skin diseases such as skin cancers and port-wine stains. It offers several benefits such as non-invasiveness and selective treatment. However, the use of light, e.g., laser, for safe and effective photothermolysis becomes challenging due to the limited penetration of light into skin tissue as well as the presence of melanin, which absorbs this light. To solve the current issues, we propose an optical microneedle-lens array (OMLA) coated with gold in this work to directly deliver light to targeted skin layers without being absorbed by surrounding tissues as well as melanin, which results in the improvement of the efficiency of photothermal therapy. We developed a novel fabrication method, frame-guided micromolding, to prepare the OMLA by assembling two negative molds with simultaneous alignment. In addition, evaluations of the optical and heat transfer characteristics of the OMLA were performed. We expect our developed OMLA to play a crucial role in realizing more effective laser therapy by allowing the precise delivery of photons to the target area.
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Affiliation(s)
- Jongho Park
- Institute of Industrial Science, The University of Tokyo, Tokyo 153-8505, Japan;
| | - Kotaro Shobayashi
- Department of Precision Engineering, School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan;
| | - Beomjoon Kim
- Institute of Industrial Science, The University of Tokyo, Tokyo 153-8505, Japan;
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Gao C, Nguyen V, Hochman ML, Gao L, Chen EH, Friedman HI, Nelson JS, Tan W. Current clinical evidence is insufficient to support HMME-PDT as the first choice of treatment for young children with port wine birthmarks. Lasers Surg Med 2024; 56:321-333. [PMID: 38506454 DOI: 10.1002/lsm.23779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/21/2024]
Abstract
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 (C0), 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 (C0, 0.54 vs. 0.48, p = 0.733), subpopulations with only minors (C0, 0.54 vs. 0.46, p = 0.714), and young children (C0, 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.
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Affiliation(s)
- Chao Gao
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Vi Nguyen
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Marcelo L Hochman
- The Facial Surgery Center and the Hemangioma & Malformation Treatment Center, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lin Gao
- Department of Dermatology, XiJing Hospital, Xi'an, Shaanxi, China
| | - Elliott H Chen
- Division of Plastic Surgery, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Division of Plastic Surgery, Prisma Health Medical Group, Columbia, South Carolina, USA
| | - Harold I Friedman
- Division of Plastic Surgery, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Division of Plastic Surgery, Prisma Health Medical Group, Columbia, South Carolina, USA
| | - John Stuart Nelson
- Departments of Surgery and Biomedical Engineering, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California, USA
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, USA
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Wang M, Singh R, Zhang W, Orringer JS, Paulus YM, Yang X, Wang X. Cutaneous Hypervascularization Treatment Using Photo-Mediated Ultrasound Therapy. JID INNOVATIONS 2023; 3:100237. [PMID: 38024557 PMCID: PMC10661455 DOI: 10.1016/j.xjidi.2023.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 12/01/2023] Open
Abstract
Photo-mediated ultrasound therapy (PUT) is a cavitation-based, highly selective antivascular technique. In this study, the effectiveness and safety of PUT on cutaneous vascular malformation was examined through in vivo experiments in a clinically relevant chicken wattle model, whose microanatomy is similar to that of port-wine stain and other hypervascular dermal diseases in humans. Assessed by optical coherence tomography angiography, the blood vessel density in the chicken wattle decreased by 73.23% after one session of PUT treatment in which 0.707 J/cm2 fluence laser pulses were applied concurrently with ultrasound bursts (n = 7, P < .01). The effectiveness of removing blood vessels in the skin at depth up to 1 mm was further assessed by H&E-stained histology at multiple time points, which included days 1, 3, 7, 14, and 21 after treatment. Additional immunohistochemical analyses with CD31, caspase-3, and Masson's trichrome stains were performed on day 3 after treatment. The results show that the PUT-induced therapeutic effect was confined and specific to blood vessels only, whereas unwanted collateral damage in other skin tissues such as collagen was avoided. The findings from this study demonstrate that PUT can efficiently and safely remove hypervascular dermal capillaries using laser fluence at a level that is orders of magnitude smaller than that used in conventional laser treatment of vascular lesions, thus offering a safer alternative technique for clinical management of cutaneous vascular malformations.
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Affiliation(s)
- Mingyang Wang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Rohit Singh
- PhotoSonoX LLC, Ann Arbor, Michigan, USA
- Institute for Bioengineering Research, University of Kansas, Lawrence, Kansas, USA
- Department of Mechanical Engineering, School of Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Wei Zhang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Yannis M. Paulus
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Xinmai Yang
- Institute for Bioengineering Research, University of Kansas, Lawrence, Kansas, USA
- Department of Mechanical Engineering, School of Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Eckembrecher FJ, Eckembrecher DG, Camacho I, Shah H, Jaalouk D, Nouri K. A review of treatment of port-wine stains with pulsed dye laser in fitzpatrick skin type IV-VI. Arch Dermatol Res 2023; 315:2505-2511. [PMID: 37253863 DOI: 10.1007/s00403-023-02640-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/12/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Francelia J Eckembrecher
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
- San Juan Bautista School of Medicine, Caguas, PR, USA.
| | - Daphne G Eckembrecher
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- San Juan Bautista School of Medicine, Caguas, PR, USA
| | - Isabella Camacho
- MedStar Washington Hospital Center/Georgetown University Hospital, Washington, DC, USA
| | | | - Dana Jaalouk
- Florida State University College of Medicine, Tallahassee, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Wang JV, Bajaj S, Murgia R, Wu SZ, Weiss R, Geronemus RG, Ibrahimi OA, Kilmer S. Safety and Efficacy of a Novel, Variable-Sequenced, Long-Pulsed, 532-nm and 1,064-nm Laser With Cryogen Spray Cooling for Pigmented and Vascular Lesions. Dermatol Surg 2023; 49:689-692. [PMID: 37184483 DOI: 10.1097/dss.0000000000003831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Patients frequently seek treatment for vascular and pigmented lesions. More recently, a novel, variable-sequenced, long-pulsed, 532-nm and 1,064-nm laser with cryogen spray cooling was developed to offer greater flexibility in treatments. OBJECTIVE A prospective clinical trial evaluated the safety and efficacy of a novel, variable-sequenced, long-pulsed, 532-nm and 1,064-nm laser with cryogen spray cooling (DermaV, Lutronic, South Korea). MATERIALS AND METHODS Subjects with vascular and/or pigmented lesions were enrolled and underwent laser treatments. RESULTS Twenty-three subjects were enrolled with vascular lesions (39.1%), pigmented lesions (17.4%), and both (43.5%). Mean age was 53.1 years, and 91.3% were women. Fitzpatrick skin types II-IV were included. All subjects were treated with 532 nm, and 4 were also treated with 1,064 nm. According to 4 blinded physician reviewers, correct before and after photographs were selected in 94.7%, 92.1%, 84.2%, and 76.3% of cases. Overall, 86.8% were responders, meaning that at least 3 of 4 reviewers agreed. For Global Aesthetic Improvement Scale, improvement occurred in 81.6%, 81.6%, 81.6%, and 76.3% of cases. No serious adverse events occurred. Overall, 87.0% of subjects reported being very satisfied or satisfied. CONCLUSION A novel, variable-sequenced, long-pulsed, 532-nm and 1,064-nm laser with cryogen spray cooling can safely and effectively improve vascular and pigmented lesions.
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Affiliation(s)
- Jordan V Wang
- Laser and Skin Surgery Center of New York, New York, New York
| | - Shirin Bajaj
- Laser and Skin Surgery Center of New York, New York, New York
| | - Robert Murgia
- Maryland Dermatology Laser Skin and Vein, Hunt Valley, Maryland
| | - Sean Z Wu
- Maryland Dermatology Laser Skin and Vein, Hunt Valley, Maryland
| | - Robert Weiss
- Maryland Dermatology Laser Skin and Vein, Hunt Valley, Maryland
| | - Roy G Geronemus
- Laser and Skin Surgery Center of New York, New York, New York
| | | | - Suzanne Kilmer
- Laser and Skin Surgery Center of Northern California, Sacramento, California
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8
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Chua CJ, Pandey PK, Kelly KM, Xiang L. Feasibility of photoacoustic-guided ultrasound treatment for port wine stains. Lasers Surg Med 2023; 55:46-60. [PMID: 36208102 PMCID: PMC9892359 DOI: 10.1002/lsm.23609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/27/2022] [Accepted: 09/26/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Port wine birthmark, also known as port wine stain (PWS) is a skin discoloration characterized by red/purple patches caused by vascular malformation. PWS is typically treated by using lasers to destroy abnormal blood vessels. The laser heating facilitates selective photothermolysis of the vessels and attenuates quickly in the tissue due to high optical scattering. Therefore, residual abnormal capillaries deep in the tissue survive and often lead to the resurgence of PWS. Ultrasound (US) has also been proposed to treat PWS, however, it is nonselective with respect to the vasculature but penetrates deeper into the tissue. We aim to study the feasibility of a hybrid PWS treatment modality combining the advantages of both modalities. MATERIALS AND METHODS In this manuscript, we propose a photoacoustic (PA) guided US focusing methodology for PWS treatment which combines the optical contrast-based selectivity with US penetration to focus the US energy onto the vasculature. The PA signals collected by the transducers, when time-reversed, amplified, and transmitted, converge onto the PWS, thus minimally affecting the neighboring tissue. We performed two- and three-dimensional simulations that mimic realistic transducers and medium properties in this proof of concept study. RESULTS The time-reversed PA signals when transmitted from the transducers converged onto the vasculature, as expected, thus reducing the heating of the neighboring tissue. We observed that while the US focus is indeed affected due to experimental factors such as limited-view, large detector separation and finite detection bandwidth, and so forth, the US did focus completely or partially onto the vasculature demonstrating the feasibility of the proposed methodology. CONCLUSION The results demonstrate the potential of the proposed methodology for PWS treatment. This treatment method can destroy the deeper capillaries while minimally heating the neighboring tissue, thus reducing the chances of the resurgence of PWS and as well as cosmetic scarring.
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Affiliation(s)
- Chloe J Chua
- Department of Biomedical Engineering, University of California, Irvine, CA 92617, USA
| | - Prabodh Kumar Pandey
- Department of Radiological Sciences, University of California, Irvine, CA, 92697, USA
| | - Kristen M Kelly
- Department of Dermatology, University of California, Irvine, CA 92697, USA
- Beckman Laser Institute, University of California, Irvine, CA 92612, USA
| | - Liangzhong Xiang
- Department of Biomedical Engineering, University of California, Irvine, CA 92617, USA
- Department of Radiological Sciences, University of California, Irvine, CA, 92697, USA
- Beckman Laser Institute, University of California, Irvine, CA 92612, USA
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9
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Transient Thermal Response of Blood Vessels during Laser Irradiation Monitored by Laser Speckle Contrast Imaging. PHOTONICS 2022. [DOI: 10.3390/photonics9080520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Real-time monitoring of blood flow and thrombosis formation induced by laser irradiation is critical to reveal the thermal-damage mechanism and successfully implement vascular-dermatology laser surgery. Laser speckle contrast imaging (LSCI) is a non-invasive technique to visualize perfusion in various tissues. However, the ability of the LSCI to monitor the transient thermal response of blood vessels, especially thrombus formation during laser irradiation, requires further research. In this paper, an LSCI system was constructed and a 632 nm He-Ne laser was employed to illuminate a Sprague Dawley rat dorsal skin chamber model irradiated by a 1064 nm Nd: YAG therapy laser. The anisotropic diffusion filtering (ADF) technique is implemented after temporal LSCI (tLSCI) processing to improve the SNR and temporal resolution. The speckle flow index is used to characterize the blood-flow velocity to reduce the computational cost. The combination of the tLSCI and ADF increases the temporal resolution by five times and the SNR by 17.2 times and 16.14 times, without and with laser therapy, respectively. The laser-induced thrombus formation and vascular damage during laser surgery can be visualized without any exogenous labels, which provides a powerful tool for thrombus monitoring during laser surgery.
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10
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Jantarakolica T, Wanitphakdeedecha R, Yan C, Ng JNC, Sudhipongpracha T. Price decomposition of laser treatment for port-wine stain using the hedonic pricing model. J Cosmet Dermatol 2022; 21:998-1003. [PMID: 35037364 DOI: 10.1111/jocd.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Port-wine stain (PWS) is a congenital capillary malformation associated with negative effects on the quality of life and psychological health of the patients. Pulsed dye laser (PDL) is the current treatment of choice for PWS; however, there is little information on the factors determining the treatment price of PWS. We aim to explore the factors determining the treatment price of PWS. METHODS Data were collected through telephone surveys and self-reported questionnaires from hospitals, chain clinics, and doctor's offices that offered PWS treatment from February 1 to March 30, 2021. Data were analyzed by descriptive statistics and multivariate analysis using a log-linear regression model. RESULTS A total of 104 observations were gathered. The estimated base price of the treatment without any additional features is 98.34 USD. Treatment by dermatologists has an additional charge of 28.41 USD or 28.9%. Some private clinics offer a lower price of 28.7% (or 28.27 USD) by illegally having non-medical doctors perform the treatment. Treatment with 595-nm PDL and 585-nm PDL and 1064-nm Nd:YAG lasers has an additional charge of 34% (or 33.45 USD) and 38% (or 37.41 USD), respectively. The location and type of medical facility can also affect the price of the treatment. CONCLUSION Many factors determine the base price and shadow price of PWS treatment. Factors determining a higher cost of laser fee includes non-government facilities, location within the capital city, and shopping complexes (high-cost location). Lastly, the type of laser and medical personnel provider can also affect the price of the treatment.
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Affiliation(s)
| | - Rungsima Wanitphakdeedecha
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,College of Interdisciplinary Studies, Thammasat University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Janice Natasha C Ng
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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11
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Li D, Wu WJ, Li K, Zhang H, Chen B, Ying ZX, Liao DY. Wavelength optimization for the laser treatment of port wine stains. Lasers Med Sci 2021; 37:2165-2178. [PMID: 34845565 DOI: 10.1007/s10103-021-03478-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
Based on the well-known principle of selective photothermolysis, laser has been a promising way for the treatment of port wine stains (PWSs). The laser wavelengths used for PWS's clinical treatment include but are not limited to pulsed dye laser (PDL) in 585-600 nm, long-pulse 755-nm alexandrite, and 1064-nm Nd:YAG lasers. The objective of this study was to investigate the optimal wavelength for PWS's laser treatment. A two-scale mathematic model was constructed to simultaneously quantify macroscale laser energy attenuation in two-layered bulk skin and microscale local energy absorption on target blood vessels within Krogh unit. The effects of morphological parameters, including epidermal melanin content, epidermal thickness, dermal blood content, blood vessel depth, and diameter on laser energy deposition within target blood vessels, were investigated from the visible to near-infrared bands (500-1100 nm). The energy deposition ratio of target blood vessel to epidermal surface was proposed to determine the optimal laser wavelength for PWS with different skin morphological parameters. The bioheat transfer modeling and animal experiment are also conducted to prove our wavelength optimization. The optimal wavelengths for lightly pigmented skin with small and shallow target blood vessels are 580-610 nm in the visible band. This wavelength coincides with commercially used PDL. The optimal wavelength shifts to 940 nm as the epidermal pigmentation increases or the size and blood vessel depth increases. The optimal wavelength changes to 1005 nm as the epidermal pigmentation or the size and burying depth of target blood vessel further increases. Nine hundred forty nanometers can be selected as a general wavelength in PWS treatment to meet the need in most widely morphological structure. Lasers with wavelengths in the 580-610, 940, and 1005 nm regions are effective for treating PWS because of their high optical selectivity in blood over the epidermis.
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Affiliation(s)
- D Li
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - W J Wu
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - K Li
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - H Zhang
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - B Chen
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China.
| | - Z X Ying
- Shaanxi Institute of Endemic Disease Prevention and Control, Xi'an, 710003, Shaanxi, China
| | - D Y Liao
- Peking University Shenzhen Hospital, Shenzhen, 518036, China.
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Chen D, Wang Y, Zhao H, Qiu H, Wang Y, Yang J, Gu Y. Monitoring perfusion and oxygen saturation in port-wine stains during vascular targeted photodynamic therapy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:214. [PMID: 33708841 PMCID: PMC7940906 DOI: 10.21037/atm-20-3210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Vascular targeted photodynamic therapy (V-PDT) is a safe and effective therapeutic modality for port-wine stains (PWS) by targetedly damaging the dilated and malformed blood vessels. This study aims to monitor and quantify the changes in oxygen saturation (StO2), blood volume fraction (BVF) and perfusion in PWS lesions before and during V-PDT. Methods Microvascular parameters (i.e., StO2 and BVF) and skin perfusion were measured noninvasively by using diffuse reflectance spectroscopy (DRS) and laser Doppler imaging (LDI), respectively. The change in StO2, BVF and perfusion that occurred in the PWS lesions of 26 patients were monitored and investigated before and during V-PDT in vivo with the systematic administration of the porphyrin-based photosensitizer HiPorfin. Results The mean StO2 (P<0.05), BVF (P<0.05), and perfusion (P<0.001) in PWS lesions of all subjects significantly increased by 6%, 34%, and 113%, respectively, 3 min after the initiation of V-PDT. The StO2 increased first and fluctuated during V-PDT. The overall trend of BVF change was consistent with the perfusion change. The BVF and the perfusion of PWS lesions increased after the initiation of V-PDT, and then gradually decreased. Conclusions V-PDT is an effective therapeutic modality in treating PWS. Results showed that LDI and DRS permitted the noninvasive monitoring of the changes in StO2, BVF, and perfusion in PWS lesions during V-PDT, and these methods can be useful in facilitating our understanding of the basic physiological mechanisms during V-PDT.
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Affiliation(s)
- Defu Chen
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing, China.,Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing, China
| | - Ying Wang
- Department of Laser Medicine, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongyou Zhao
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing, China
| | - Haixia Qiu
- Department of Laser Medicine, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yongtian Wang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing, China
| | - Jian Yang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing, China
| | - Ying Gu
- Department of Laser Medicine, First Medical Center of Chinese PLA General Hospital, Beijing, China.,Precision laser medical diagnosis and treatment Innovation unit, Chinese Academy of Medical Sciences, Beijing, China
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Wang M, Qin Y, Wang T, Orringer JS, Paulus YM, Yang X, Wang X. Removing Subcutaneous Microvessels Using Photo-Mediated Ultrasound Therapy. Lasers Surg Med 2020; 52:984-992. [PMID: 32394475 PMCID: PMC7655656 DOI: 10.1002/lsm.23260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES We have developed a novel anti-vascular technique, termed photo-mediated ultrasound therapy (PUT), which utilizes nanosecond duration laser pulses synchronized with ultrasound bursts to remove the microvasculature through cavitation. The objective of the current study is to explore the potential of PUT in removing subcutaneous microvessels. STUDY DESIGN/MATERIALS AND METHODS The auricular blood vessels of two New Zealand white rabbits were treated by PUT with a peak negative ultrasound pressure of 0.45 MPa at 0.5 MHz, and a laser fluence of 0.056 J/cm2 at 1064 nm for 10 minutes. Blood perfusion in the treated area was measured by a commercial laser speckle imaging (LSI) system before and immediately after treatment, as well as at 1 hour, 3 days, 2 weeks, and 4 weeks post-treatment. Perfusion rates of 38 individual vessels from four rabbit ears were tracked during this time period for longitudinal assessment. RESULTS The measured perfusion rates of the vessels in the treated areas, as quantified by the relative change in perfusion rate, showed a statistically significant decrease for all time points post-treatment (P < 0.001). The mean decrease in perfusion is 50.79% immediately after treatment and is 32.14% at 4 weeks post-treatment. Immediately after treatment, the perfusion rate decreased rapidly. Following this, there was a partial recovery in perfusion rate up to 3 days post-treatment, followed by a plateau in the perfusion from 3 days to 4 weeks. CONCLUSIONS This study demonstrated that a single PUT treatment could significantly reduce blood perfusion by 32.14% in the skin for up to 4 weeks. With unique advantages such as low laser fluence as compared with photothermolysis and agent-free treatment as compared with photodynamic therapy, PUT holds the potential to be developed into a new tool for the treatment of cutaneous vascular lesions. Lasers Surg. Med. © 2020 Wiley Periodicals, LLC.
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Affiliation(s)
- Mingyang Wang
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
| | - Yu Qin
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, No.1239, Siping Road, Shanghai, 200092, China
| | - Tao Wang
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
- Institution of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, 236 Baidi Road, Tianjin, 300192, China
| | - Jeffrey S Orringer
- Department of Dermatology, University of Michigan, 1910 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48109
| | - Yannis M Paulus
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
- Department of Ophthalmology and Visual Sciences, University of Michigan, W.K. Kellogg Eye Center, 1000 Wall Street, Ann Arbor, Michigan, 48109
| | - Xinmai Yang
- Institute for Bioengineering Research and Department of Mechanical Engineering, University of Kansas, 1530 W.15th Street, 3138 Learned Hall, Lawrence, Kansas, 66045
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, 2200 Bonisteel Blvd, Ann Arbor, Michigan, 48109
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van Raath MI, Chohan S, Wolkerstorfer A, van der Horst CMAM, Limpens J, Huang X, Ding B, Storm G, van der Hulst RRWJ, Heger M. Clinical outcome measures and scoring systems used in prospective studies of port wine stains: A systematic review. PLoS One 2020; 15:e0235657. [PMID: 32614899 PMCID: PMC7332045 DOI: 10.1371/journal.pone.0235657] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Valid and reliable outcome measures are needed to determine and compare treatment results of port wine stain (PWS) studies. Besides, uniformity in outcome measures is crucial to enable inter-study comparisons and meta-analyses. This study aimed to assess the heterogeneity in reported PWS outcome measures by mapping the (clinical) outcome measures currently used in prospective PWS studies. METHODS OVID MEDLINE, OVID Embase, and CENTRAL were searched for prospective PWS studies published from 2005 to May 2020. Interventional studies with a clinical efficacy assessment were included. Two reviewers independently evaluated methodological quality using a modified Downs and Black checklist. RESULTS In total, 85 studies comprising 3,310 patients were included in which 94 clinician/observer-reported clinical efficacy assessments had been performed using 46 different scoring systems. Eighty-one- studies employed a global assessment of PWS appearance/improvement, of which -82% was expressed as percentage improvement and categorized in 26 different scoring systems. A wide variety of other global and multi-item scoring systems was identified. As a result of outcome heterogeneity and insufficient data reporting, only 44% of studies could be directly compared. A minority of studies included patient-reported or objective outcomes. Thirteen studies of good quality were found. CONCLUSION Clinical PWS outcomes are highly heterogeneous, which hampers study comparisons and meta-analyses. Consensus-based development of a core outcome-set would benefit future research and clinical practice, especially considering the lack of high-quality trials.
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Affiliation(s)
- M. Ingmar van Raath
- Department of Pharmaceutics, Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sandeep Chohan
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Chantal M. A. M. van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Xuan Huang
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Baoyue Ding
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Gert Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - René R. W. J. van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Michal Heger
- Department of Pharmaceutics, Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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15
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Dong W, Zhang X, Lu Z. Effect of 532nm photodynamic therapy with hemoporfin on the expression of vascular endothelial growth factor in cultured human vascular endothelial cells. Photodiagnosis Photodyn Ther 2020; 30:101793. [PMID: 32344194 DOI: 10.1016/j.pdpdt.2020.101793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/28/2020] [Accepted: 04/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) with hemoporfin (hematoporphyrinmonomethyl ether, HMME) and 532 nm continuous-wave lasers is effective for port-wine stains (PWS) and is considered as a promising treatment modality. The vascular endothelial growth factor (VEGF) is involved in the development of PWS. This study aimed to investigate the effect of 532 nm-HMME-PDT on the in vitro expression of VEGF in human umbilical vein endothelial cells (HUVECs) exposed to different power levels of 532 nm laser and different concentrations of HMME. METHOD The CCK-8 assay was performed to assess cell viability. Enzyme-linked immunosorbent assay (ELISA) was performed to measure VEGF secretion. VEGF and VEGF receptor (VEGFR) mRNA expression levels were detected by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). RESULTS Within 72 h after HMME-PDT, cell viability was inhibited, secretion and expression of VEGF was decreased, and expression of VEGFR mRNA was significantly decreased with the increase of HMME concentration. CONCLUSION 532 nm-HMME-PDT can downregulate the expression of VEGF and VEGFR mRNA. Future studies are necessary to examine the HMME doses to achieve better efficacy with fewer adverse effects.
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Affiliation(s)
- Wenxin Dong
- Department of Dermatology, Huashan Hospital Fudan University, Shanghai, China; Department of Medical Cosmetic Center, Shanghai Skin Disease Hospital, Shanghai, China
| | - Xuting Zhang
- Department of Dermatology, Huashan Hospital Fudan University, Shanghai, China; Department of Dermatology, Shanghai Sixth People's Hospital, Shanghai, China
| | - Zhong Lu
- Department of Dermatology, Huashan Hospital Fudan University, Shanghai, China.
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Thermal coagulum formation and hemostasis during repeated multipulse Nd:YAG laser treatment of cutaneous vascular lesions: animal experiment study. Lasers Med Sci 2020; 35:1589-1597. [PMID: 32277406 DOI: 10.1007/s10103-020-03007-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
Laser therapy has been widely used to treat port-wine stain (PWS) and other cutaneous vascular lesions via selective photothermolysis. High incident laser fluence is always prohibited in clinic to prevent the thermal damage in normal skin tissue, leading to insufficient energy deposition on the target blood vessel and incomplete clearance of PWS lesion. In this study, repeated multipulse laser (RMPL) irradiation was proposed to induce acute thermal damage to target blood vessels with low incident fluence (40 J/cm2 for 1064-nm Nd:YAG laser). The feasibility of the method was investigated using animal models. Repeated multipulse irradiation cycles with 10-min intervals were performed in RMPL. A hamster dorsal skin chamber model with a visualization system was constructed to investigate the instant generation of thermal coagulum and relevant hemostasis by thrombus formation during and after irradiation under 1064 nm Nd:YAG single multipulse laser (SMPL) and RMPL irradiation. The diameter of the target blood vessel and the size of thermal coagula were measured before and after laser irradiation. The reflectance spectra of the dorsal skin were measured by a reflectance spectrometer during RMPL. Stasis thermal coagula that clogged the vessel lumen were generated during SMPL irradiation with low incident fluence. However, there was no acute thermal damage of blood vessels. Reflectance spectra measurement showed that the generation of thermal coagula and subsequent thrombus formation increases blood absorption by more than 10% within the first 10 min after laser irradiation. Acute vessel thermal damage could be induced in the target blood vessel by RMPL with low incident fluence of 40 J/cm2. Compared with our previous SMPL study, nearly 30% reduction in incident laser fluence was achieved by RMPL. Low fluence RMPL may be a promising approach to improve the therapeutic outcome for patients with cutaneous vascular lesions by improving energy deposition on the target blood vessel.
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Li D, Chen B, Zhang H, Yuan Y, Fan W, Ying Z. Retrospective study of the treatment of port-wine stains with 595-nm pulsed dye laser in 261 Chinese patients. Lasers Med Sci 2020; 35:1811-1819. [PMID: 32277405 DOI: 10.1007/s10103-020-03013-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/29/2020] [Indexed: 12/14/2022]
Abstract
Pulsed dye laser (PDL) at the wavelength of 595 nm is the common choice for the treatment of port-wine stains (PWSs). In this study, the efficacy of 595-nm PDL in treatment of PWSs in Chinese patients was investigated. A follow-up visit was performed on 261 Fitzpatrick skin type II-III Chinese patients with PWS who received more than two treatments with 595-nm PDL. Based on cosmetic improvement, treatment response was graded as follows: complete, if color blanching was > 90%; significant, if color blanching was 60-90%; moderate, if color blanching was 30-60%; and poor, if color blanching was < 30%. The efficacy of laser treatment on patients of different treatment numbers, ages, lesion locations, lesion colors, extents of hypertrophy, and laser pulse durations was evaluated. All patients improved following an average of almost 4 to 5 laser treatments. The earlier the intervention, the better the efficacy was. Lesions on cheek, neck, and forehead were better than that those on oral, eye periorbital, and nose areas. The purple group had a more excellent clearance, i.e., complete and significant clearance rate (53.6%), than the red group (36.1%). Treatment effect became worse as the extent of lesion hypertrophy increased. PWS lesions treated with short pulse durations of 0.45, 1.5, and 3 ms had better clearance (complete and significant clearance) rate of 56.5% than those treated with pulse durations of 6 ms or longer (34.8%). Pulsed dye laser with 595-nm laser equipped with dynamic cooling device is an effective option for the treatment of PWS in Chinese patients. Younger patients with lateral face position, larger vessel size (deeper color), and lesser hypertrophy received better clinical effect than the others. Treatment with short pulse duration of less than 3 ms for 4 to 5 times was recommended to treat PWS.
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Affiliation(s)
- Dong Li
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Bin Chen
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China.
| | - Hao Zhang
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Yuan Yuan
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Wenxin Fan
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Zhaoxia Ying
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China.
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18
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Experimental investigations on thermal effects of a long-pulse alexandrite laser on blood vessels and its comparison with pulsed dye and Nd:YAG lasers. Lasers Med Sci 2020; 35:1555-1566. [PMID: 32060655 DOI: 10.1007/s10103-020-02981-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
Laser has been widely used in the treatment of vascular skin diseases, such as port wine stain, due to the effect of selective photothermolysis in laser on biological tissue. The 755 nm alexandrite laser was expected to achieve better curative effect than the commonly used 585 or 595 nm pulsed dye laser (PDL) because of its deeper tissue penetration. In this study, the dorsal chamber model and microscopic visualization system were used to observe morphology changes on 42 blood vessels before and after irradiation with the 755 nm laser. Results showed that thermal effects of blood vessels intensified with the increase in energy, and high energy was required to produce the same thermal effect as the extension of pulse width. Different from 595 and 1064 nm lasers, partial vessel contraction was dominant thermal effect caused by the 755 nm laser. The bleeding injury rate and thermal effect of the 755 nm laser were between those of 595 nm PDL and 1064 nm Nd:YAG laser. The simulation results proved that 595 nm PDLs were effective for small and shallow target blood vessels. The 755 nm alexandrite lasers were effective in the treatment of hypertrophic and resistant blood vessels to PDL in the skin with low or moderate melanin concentration. The 1064 nm Nd:YAG laser was effective in the treatment of deeply buried and enlarged target blood vessels in the skin with high melanin concentration. The simulation results were supported by published clinical observations.
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Theoretical Study on Pressure Damage Based on Clinical Purpura during the Laser Irradiation of Port Wine Stains with Real Complex Vessels. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9245478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Port wine stains (PWSs) are congenital dermal vascular lesions composed of a hyperdilated vasculature. Purpura represented by local hemorrhage from water vaporization in blood during laser therapy of PWS is typically considered a clinical feedback, but with a low cure rate. In this study, light propagation and heat deposition in skin and PWSs is simulated by a tetrahedron-based Monte Carlo method fitted to curved bio-tissues. A curvature-corrected pressure damage model was established to accurately evaluate the relationship between purpura-bleeding area (rate) and laser therapy strategy for real complex vessels. Results showed that the standard deviation of Gaussian curvature of the vessel wall has negative relation with the fluence threshold of vessel rupture, but has positive relation with the effective laser fluence of vessel damage. This finding indicated the probable reason for the poor treatment of PWS, that is, considering purpura formation as a treatment end point (TEP) only leads to partial removal of vascular lesions. Instead, appropriate purpura area ratio with marked effects or rehabilitation should be adopted as TEP. The quantitative correlation between the fluence of a pulsed dye laser and the characteristics of vascular lesions can provide personalized and precise guidance for clinical treatments.
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20
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Khalkhal E, Rezaei-Tavirani M, Zali MR, Akbari Z. The Evaluation of Laser Application in Surgery: A Review Article. J Lasers Med Sci 2019; 10:S104-S111. [PMID: 32021682 DOI: 10.15171/jlms.2019.s18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There are several types of surgeries which use lasers in the operating room. Surgeons use lasers in general surgery or surgical specialties to cut, coagulate, and remove tissue. In modern medicine, the application of laser therapy is an attractive subject due to its minimal invasive effect. Today lasers are widely used in the treatment and diagnosis of many diseases such as various cancers, lithotripsy, ophthalmology, as well as dermatology and beauty procedures. Depending on the type of lasers, the wavelength and the delivery system, most lasers have replaced conventional surgical instruments for better wound healing results. Over time, by using many different tools and devices, new lasers have been created; as a result, they are used in a wide range of medical special cases. In this review, laser applications in surgery and its beneficial effects compared to previous surgeries with the aim of providing appropriate therapeutic and non-invasive solutions with minimal side effects after surgery are investigated.
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Affiliation(s)
- Ensieh Khalkhal
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Akbari
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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21
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Ying ZX, Zhao YB, Li D, Shang YL, Chen B, Jia WC. The influence of morphological distribution of melanin on parameter selection in laser thermotherapy for vascular skin diseases. Lasers Med Sci 2019; 35:901-917. [PMID: 31701386 DOI: 10.1007/s10103-019-02882-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/12/2019] [Indexed: 11/24/2022]
Abstract
Port wine stains (PWSs) are congenital vascular malformations that progressively darken and thicken with age. Currently, laser therapy is the most effective way in clinical management of PWS. It is known that skin pigmentation (melanin content) affects the radiant exposure that can be safely applied to treat PWS. However, the effect of melanin distribution in the epidermis on the maximum safe radiant exposure has not been studied previously. In this study, 10 different morphological distributions of melanin were proposed according to the formation and migration characteristics of melanin, and the two-scale heat transfer model was employed to investigate the influence of melanin distribution on the threshold radiant exposure of epidermis and blood vessels. The results show that melanin distributions do have a strong effect on laser parameter selection. When uniform melanin distribution is assumed, the threshold radiant exposure to damage a typical PWS blood vessel (50 μm diameter) is 8.62 J/cm2 lower than that to injure epidermis. The optimal pulse duration is 1-5 ms for a typical PWS blood vessel of 50 μm when melanin distribution is taken into consideration. PWS blood vessels covered by non-uniformly distributed melanin are more likely to have poor response to laser treatment.
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Affiliation(s)
- Z X Ying
- Department of Dermatology, the Second Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China
| | - Y B Zhao
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710069, Shaanxi, China
| | - D Li
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710069, Shaanxi, China.
| | - Y L Shang
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710069, Shaanxi, China
| | - B Chen
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, 710069, Shaanxi, China.
| | - W C Jia
- Beckman Laser Institution and Medical Clinic, University of California, Irvine, 92697, CA, USA
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van Raath M, Chohan S, Wolkerstorfer A, van der Horst C, Storm G, Heger M. Port wine stain treatment outcomes have not improved over the past three decades. J Eur Acad Dermatol Venereol 2019; 33:1369-1377. [PMID: 30908756 PMCID: PMC6618082 DOI: 10.1111/jdv.15599] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Since the early '80s, the pulsed dye laser has been the standard treatment tool for non-invasive port wine stain (PWS) removal. In the last three decades, a considerable amount of research has been conducted to improve clinical outcomes, given that a fraction of PWS patients proved recalcitrant to laser treatment. Whether this research actually led to increased therapeutic efficacy has not been systematically investigated. OBJECTIVE To analyse therapeutic efficacy in PWS patients globally from 1986 to date. METHODS PubMed was searched for all available PWS trials. Studies with a quartile percentage improvement scale were included, analysed and plotted chronologically. Treatment and patient characteristics were extracted. A mean clearance per study was calculated and plotted. A 5-study simple moving average was co-plotted to portray the trend in mean clearance over time. The data were separately analysed for multiple treatment sessions in previously untreated patients. RESULTS Sixty-five studies were included (24.3% of eligible studies) comprising 6207 PWS patients. Of all patients, 21% achieved 75-100% clearance. Although a few studies reported remarkably good outcomes in a subset of carefully selected patients, there was no upward trend over time in mean clearance. CONCLUSION The efficacy of PWS therapy has not improved in the past decades, despite numerous technical innovations and pharmacological interventions. With an unwavering patient demand for better outcomes, the need for development and implementation of novel therapeutic strategies to clear all PWS is as valid today as it was 30 years ago.
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Affiliation(s)
- M.I. van Raath
- Department of PharmaceuticsCollege of MedicineJiaxing UniversityJiaxingChina
- Department of Experimental SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - S. Chohan
- Department of Experimental SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - A. Wolkerstorfer
- Department of DermatologyAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - C.M.A.M. van der Horst
- Department of Plastic, Reconstructive, and Hand SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - G. Storm
- Department of PharmaceuticsUtrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtthe Netherlands
- Department of Controlled Drug DeliveryMIRA Institute for Biomedical Technology and Technical MedicineUniversity of TwenteEnschedethe Netherlands
| | - M. Heger
- Department of PharmaceuticsCollege of MedicineJiaxing UniversityJiaxingChina
- Department of Experimental SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Department of PharmaceuticsUtrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtthe Netherlands
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Burns JM, Jia W, Nelson JS, Majaron B, Anvari B. Photothermal treatment of port-wine stains using erythrocyte-derived particles doped with indocyanine green: a theoretical study. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-10. [PMID: 30499264 PMCID: PMC6318811 DOI: 10.1117/1.jbo.23.12.121616] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/02/2018] [Indexed: 05/20/2023]
Abstract
Pulsed dye laser irradiation in the wavelength range of 585 to 600 nm is currently the gold standard for treatment of port-wine stains (PWSs). However, this treatment method is often ineffective for deeply seated blood vessels and in individuals with moderate to heavy pigmentation. Use of optical particles doped with the FDA-approved near-infrared (NIR) absorber, indocyanine green (ICG), can potentially provide an effective method to overcome these limitations. Herein, we theoretically investigate the effectiveness of particles derived from erythrocytes, which contain ICG, in mediating photothermal destruction of PWS blood vessels. We refer to these particles as NIR erythrocyte-derived transducers (NETs). Our theoretical model consists of a Monte Carlo algorithm to estimate the volumetric energy deposition, a finite elements approach to solve the heat diffusion equation, and a damage integral based on an Arrhenius relationship to quantify tissue damage. The model geometries include simulated PWS blood vessels as well as actual human PWS blood vessels plexus obtained by the optical coherence tomography. Our simulation results indicate that blood vessels containing micron- or nano-sized NETs and irradiated at 755 nm have higher levels of photothermal damage as compared to blood vessels without NETs irradiated at 585 nm. Blood vessels containing micron-sized NETs also showed higher photothermal damage than blood vessels containing nano-sized NETs. The theoretical model presented can be used in guiding the fabrication of NETs with patient-specific optical properties to allow for personalized treatment based on the depth and size of blood vessels as well as the pigmentation of the individual's skin.
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Affiliation(s)
- Joshua M. Burns
- University of California, Riverside, Department of Bioengineering, Riverside, California, United States
| | - Wangcun Jia
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - J. Stuart Nelson
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Boris Majaron
- Jožef Stefan Institute, Department of Complex Matter, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Mathematics and Physics, Ljubljana, Slovenia
| | - Bahman Anvari
- University of California, Riverside, Department of Bioengineering, Riverside, California, United States
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
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Wu Q, Tu P, Zhou G, Yang H, Zhou Z, Zhao Y, Zheng Q, Gu Y, Tao J, Zhu X. A dose-finding study for hemoporfin in photodynamic therapy for port-wine stain: A multicenter randomized double-blind phase IIb trial. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018. [PMID: 29533491 DOI: 10.1111/phpp.12384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Qiuju Wu
- Institute of Dermatology; Chinese Academy of Medical Sciences and Peking Union Medical College; Nanjing China
| | - Ping Tu
- Department of Dermatology and Venereology; Peking University First Hospital; Beijing China
| | - Guoyu Zhou
- Department of Oral Maxillofacial Surgery; Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Huilan Yang
- Department of Dermatology; The General Hospital of Guangzhou Military Command; Guangzhou China
| | - Zhanchao Zhou
- Institute of Dermatology; Chinese Academy of Medical Sciences and Peking Union Medical College; Nanjing China
| | - Yi Zhao
- Department of Dermatology and Venereology; Peking University First Hospital; Beijing China
| | - Qingshan Zheng
- Center for Drug Clinical Research; Shanghai University of Chinese Traditional Medicine; Shanghai China
| | - Ying Gu
- Department of Laser Medicine; Chinese PLA General Hospital; Beijing China
| | - Jining Tao
- Shanghai Fudan-Zhangjiang Bio-Pharmaceutical Co. Ltd; Shanghai China
| | - Xuejun Zhu
- Department of Dermatology and Venereology; Peking University First Hospital; Beijing China
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Horbach SER, Wolkerstorfer A, de Bruin DM, Jansen SM, van der Horst CMAM. Electrosclerotherapy for capillary malformations: study protocol for a randomised within-patient controlled pilot trial. BMJ Open 2017; 7:e016401. [PMID: 29138199 PMCID: PMC5695370 DOI: 10.1136/bmjopen-2017-016401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The current state-of-the-art treatment modality for hypertrophic capillary malformations (CMs), laser therapy, has a considerable rate of non-responders and recurrence. Intralesional bleomycin injections (or 'sclerotherapy') are commonly used to treat venous and lymphatic malformations with an excellent effect, but these intravascular injections are not possible in CMs due to the small diameter of the vessels. Electroporation-an electric field applied to the tissue-could increase the permeability of endothelial cells, which could theoretically facilitate targeted localised bleomycin delivery. We therefore hypothesise that bleomycin injections in combination with electroporation-'electrosclerotherapy' (EST), also known as 'electrochemotherapy'-could potentially be a novel alternative treatment option for CMs. METHODS AND ANALYSIS In this randomised within-patient controlled pilot trial, 20 patients with hypertrophic CMs will be enrolled. Three regions of interest (ROIs) within the CM will be randomly allocated for treatment with (A) EST, (B) bleomycin sclerotherapy without electroporation and (C) no treatment. Patients and outcome assessors are blinded for the treatment allocation. Treatment outcome for each ROI will be measured approximately 7 weeks after the treatment procedure, using patient-reported and physician-reported global assessment scores, colorimetry, laser speckle imaging and reporting of adverse events. ETHICS AND DISSEMINATION The study protocol is approved by the ethics review committee of the Academic Medical Center, Amsterdam. Results will be published in peer-reviewed medical journals and will be presented at international conferences and scientific meetings. Study results will be fed back to the patient population through website and social media notifications. TRIAL REGISTRATION NUMBER NCT02883023;Pre-results. NTR6169.
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Affiliation(s)
- Sophie E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Daniel Martijn de Bruin
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | | | - Chantal M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Noord-Holland, Netherlands
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Experimental investigation on the vascular thermal response to near-infrared laser pulses. Lasers Med Sci 2017; 32:2023-2038. [DOI: 10.1007/s10103-017-2311-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
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Jia H, Chen B, Li D. Dynamic optical absorption characteristics of blood after slow and fast heating. Lasers Med Sci 2017; 32:513-525. [PMID: 28091849 DOI: 10.1007/s10103-017-2143-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
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Abstract
In modern medicine, lasers are increasingly utilized for treatment of a variety of pathologies as interest in less invasive treatment modalities intensifies. The physics behind lasers allows the same basic principles to be applied to a multitude of tissue types using slight modifications of the system. Multiple laser systems have been studied within each field of medicine. The term "laser" was combined with "surgery," "ablation," "lithotripsy," "cancer treatment," "tumor ablation," "dermatology," "skin rejuvenation," "lipolysis," "cardiology," "atrial fibrillation (AF)," and "epilepsy" during separate searches in the PubMed database. Original articles that studied the application of laser energy for these conditions were reviewed and included. A review of laser therapy is presented. Laser energy can be safely and effectively used for lithotripsy, for the treatment of various types of cancer, for a multitude of cosmetic and reconstructive procedures, and for the ablation of abnormal conductive pathways. For each of these conditions, management with lasers is comparable to, and potentially superior to, management with more traditional methods.
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Affiliation(s)
- Beina Azadgoli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, Los Angeles, CA 91011, USA
| | - Regina Y Baker
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, Los Angeles, CA 91011, USA
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Correction of Facial Deformity in Sturge-Weber Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e843. [PMID: 27622111 PMCID: PMC5010334 DOI: 10.1097/gox.0000000000000843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/29/2016] [Indexed: 01/06/2023]
Abstract
Background: Although previous studies have reported soft-tissue management in surgical treatment of Sturge–Weber syndrome (SWS), there are few reports describing facial bone surgery in this patient group. The purpose of this study is to examine the validity of our multidisciplinary algorithm for correcting facial deformities associated with SWS. To the best of our knowledge, this is the first study on orthognathic surgery for SWS patients. Methods: A retrospective chart review included 2 SWS patients who completed the surgical treatment algorithm. Radiographic and clinical data were recorded, and a treatment algorithm was derived. Results: According to the Roach classification, the first patient was classified as type I presenting with both facial and leptomeningeal vascular anomalies without glaucoma and the second patient as type II presenting only with a hemifacial capillary malformation. Considering positive findings in seizure history and intracranial vascular anomalies in the first case, the anesthetic management was modified to omit hypotensive anesthesia because of the potential risk of intracranial pressure elevation. Primarily, both patients underwent 2-jaw orthognathic surgery and facial bone contouring including genioplasty, zygomatic reduction, buccal fat pad removal, and masseter reduction without major complications. In the second step, the volume and distribution of facial soft tissues were altered by surgical resection and reposition. Both patients were satisfied with the surgical result. Conclusions: Our multidisciplinary algorithm can systematically detect potential risk factors. Correction of the asymmetric face by successive bone and soft-tissue surgery enables the patients to reduce their psychosocial burden and increase their quality of life.
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Choi B, Tan W, Jia W, White SM, Moy WJ, Yang BY, Zhu J, Chen Z, Kelly KM, Nelson JS. The Role of Laser Speckle Imaging in Port-Wine Stain Research: Recent Advances and Opportunities. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2016; 2016:6800812. [PMID: 27013846 PMCID: PMC4800318 DOI: 10.1109/jstqe.2015.2493961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Here, we review our current knowledge on the etiology and treatment of port-wine stain (PWS) birthmarks. Current treatment options have significant limitations in terms of efficacy. With the combination of 1) a suitable preclinical microvascular model, 2) laser speckle imaging (LSI) to evaluate blood-flow dynamics, and 3) a longitudinal experimental design, rapid preclinical assessment of new phototherapies can be translated from the lab to the clinic. The combination of photodynamic therapy (PDT) and pulsed-dye laser (PDL) irradiation achieves a synergistic effect that reduces the required radiant exposures of the individual phototherapies to achieve persistent vascular shutdown. PDL combined with anti-angiogenic agents is a promising strategy to achieve persistent vascular shutdown by preventing reformation and reperfusion of photocoagulated blood vessels. Integration of LSI into the clinical workflow may lead to surgical image guidance that maximizes acute photocoagulation, is expected to improve PWS therapeutic outcome. Continued integration of noninvasive optical imaging technologies and biochemical analysis collectively are expected to lead to more robust treatment strategies.
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Affiliation(s)
- Bernard Choi
- Departments of Biomedical Engineering and Surgery, the Beckman Laser Institute and Medical Clinic, and the Edwards Lifesciences Center for Advanced Cardiovascular Technology, all at University of California, Irvine 92612 USA
| | - Wenbin Tan
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Wangcun Jia
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Sean M. White
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Wesley J. Moy
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | - Bruce Y. Yang
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612 USA
| | | | | | - Kristen M. Kelly
- Department of Dermatology and the Beckman Laser Institute and Medical Clinic, all at University of California, Irvine 92612 USA
| | - J. Stuart Nelson
- Departments of Biomedical Engineering and Surgery and the Beckman Laser Institute and Medical Clinic, all at University of California, Irvine 92612 USA
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Chen D, Ren J, Wang Y, Li B, Gu Y. Intraoperative monitoring of blood perfusion in port wine stains by laser Doppler imaging during vascular targeted photodynamic therapy: A preliminary study. Photodiagnosis Photodyn Ther 2016; 14:142-51. [PMID: 27068654 DOI: 10.1016/j.pdpdt.2016.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/11/2016] [Accepted: 04/05/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to monitor blood perfusion dynamics of port wine stains (PWS) during vascular targeted photodynamic therapy (V-PDT) with laser Doppler imaging (LDI). METHODS The PWS lesions of 30 facial PWS patients received V-PDT, while the normal skins on the forearm of 5 healthy subjects were treated as light-only controls for comparison. Furthermore, two different PWS lesions in the same individual from each of 3 PWS patients successively received laser irradiation only and V-PDT, respectively. LDI was used to monitor intraoperative blood perfusion dynamics. RESULTS During V-PDT, the blood perfusion (278±96 PU) in PWS lesions for 31 of 33 PWS patients significantly increased after the initiation of V-PDT treatment, then reached a peak (638±105 PU) within 10min, followed by a slow decrease to a relatively lower level (515±100 PU). Furthermore, the time for reaching peak and the subsequent magnitude of decrease in blood perfusion varied with different patients. For light-only controls, an initial perfusion peak at 3min followed by a nadir and a secondary increase were found not only in normal skin, but also in PWS lesions. CONCLUSION The preliminary results showed that the LDI permits non-invasive monitoring blood perfusion changes of PWS lesions during V-PDT. There was a clear trend in blood perfusion responses during V-PDT and laser irradiation. The blood perfusion changes during treatment were due to V-PDT effects as well as local temperature increase induced by laser irradiation.
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Affiliation(s)
- Defu Chen
- School of Information and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Jie Ren
- Department of Laser Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Ying Wang
- Department of Laser Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Buhong Li
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fujian 350007, China
| | - Ying Gu
- School of Information and Electronics, Beijing Institute of Technology, Beijing 100081, China; Department of Laser Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
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Zhao Y, Tu P, Zhou G, Zhou Z, Lin X, Yang H, Lu Z, Gao T, Tu Y, Xie H, Zheng Q, Gu Y, Tao J, Zhu X. Hemoporfin Photodynamic Therapy for Port-Wine Stain: A Randomized Controlled Trial. PLoS One 2016; 11:e0156219. [PMID: 27227544 PMCID: PMC4881994 DOI: 10.1371/journal.pone.0156219] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Photodynamic therapy (PDT) has shown potentially beneficial results in treating port-wine stain, but its benefit-risk profile remains undefined. This study aimed to evaluate the efficacy and safety of PDT conducted with hemoporfin and a 532 nm continuous wave laser to treat port-wine stain clinically. PATIENTS AND METHODS This randomized clinical trial was conducted in eight hospitals in China. Participants were adolescent and adult patients (age range: 14-65 years old) with port-wine stain. During stage 1 (day 1 to week 8) all patients were randomized at a 3:1 ratio to treatment (532 nm laser irradiation (96-120 J/cm2) with hemoporfin (5mg/kg; PDT-hemoporfin, n = 330)) or placebo groups (irradiation with placebo (PDT-placebo, n = 110)); during stage 2 (week 8 to 16) patients in both groups were offered treatment. Clinician-evaluators, who were blind to the study, classified each case on the following four-level scale according to assessment of before and after standardized pictures of the lesion area: no improvement: <20%; some improvement: 20-59%; great improvement: 60-89%; or nearly completely resolved: ≥90%. The primary efficacy endpoint was proportion of patients achieving at least some improvement at week 8. The secondary efficacy endpoints were proportion of patients achieving nearly completely resolved or at least great improvement at week 8, proportion of patients achieving early completely resolved, at least great improvement, or at least some improvement at week 16, and the corresponding satisfaction of the investigators and the patients (designated as 'excellent', 'good', 'moderate', or 'ineffective') at weeks 8 and 16. RESULTS Compared to the PDT-placebo group, the PDT-hemoporfin group showed a significantly higher proportion of patients that achieved at least some improvement (89.7% [n = 295; 95% CI, 85.9%-92.5%] vs. 24.5% [n = 27; 95% CI, 17.4%-33.3%]) at week 8 (P < 0.0001) and higher improvements for all secondary efficacy endpoints. Treatment reactions occurred in 99.5% (n = 731; 95% CI, 98.7%-99.8%) of the PDT-hemoporfin treatments (n = 735). Hyperpigmentation occurred in 22.9 per 100 patient-treatments (n = 168; 95% CI, 20.0-26.0) in the PDT-hemoporfin treated patients. CONCLUSIONS Hemoporfin-mediated PDT is an effective and safe treatment option for adolescent and adult patients with port-wine stain. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-TRC-08000213.
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Affiliation(s)
- Yi Zhao
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
| | - Guoyu Zhou
- Department of Oral Maxillofacial Surgery, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Shanghai, China
| | - Zhanchao Zhou
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Shanghai, China
| | - Huilan Yang
- Department of Dermatology, The General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Zhong Lu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianwen Gao
- Institute of Dermatology of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yating Tu
- Department of Dermatology, Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital Central South University, Changsha, China
| | - Qingshan Zheng
- Center for Drug Clinical Research, Shanghai University of Chinese Traditional Medicine, Shanghai, China
| | - Ying Gu
- Department of Laser Medicine, Chinese PLA General Hospital, Beijing, China
| | - Jining Tao
- Shanghai Fudan-Zhangjiang Bio-Pharmaceutical Co., Ltd., Shanghai, China
- * E-mail: (JT); (XZ)
| | - Xuejun Zhu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- * E-mail: (JT); (XZ)
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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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Griauzde J, Srinivasan A. Imaging of Vascular Lesions of the Head and Neck. Radiol Clin North Am 2015; 53:197-213. [DOI: 10.1016/j.rcl.2014.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Can we predict the outcome of 595-nm wavelength pulsed dye laser therapy on capillary vascular malformations from the first beginning: a pilot study of efficacy co-related factors in 686 Chinese patients. Lasers Med Sci 2014; 30:1041-6. [PMID: 25487186 DOI: 10.1007/s10103-014-1695-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
Currently, there are no standardized, objective, and clinically applicable methods to predict the outcome of pulsed dye laser (PDL) therapy on capillary vascular malformation (CVM) patients. The introduction of a method that can predict the outcome prior to treatment will be valuable for both the patients and the doctors. In this study, the authors treated CVM with 595-nm wavelength PDL in Chinese patients (n = 686) and analyzed the efficacy of treatment and complications retrospectively in a 5-year period. Nearly 18 % of patients (n = 122) had 76 % or more clearing of lesions; over 52 % of patients (n = 360) had more than 50 % of clearing. The lesions in head and neck region had the best effective rate (58.3 %), followed by trunk (42.9 %) and extremities (35.6 %). The efficacy of PDL therapy is related to age, type, and location of lesions. Fifty-seven patients (8.3 %) had complications, including 2.0 % blistering (n = 14), 4.5 % hyperpigmentation (n = 31), 1.3 % hypopigmentation (n = 9), and 0.4 % hypertrophic scarring (n = 3). Based on these preliminary data, the authors established a standardized, objective, and clinically applicable equation that may be applied to predict the efficacy of 595 nm PDL therapy on a newly diagnosed Chinese CVM patients based on the age, type, and location of lesions.
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Zhang B, Zhang TH, Huang Z, Li Q, Yuan KH, Hu ZQ. Comparison of pulsed dye laser (PDL) and photodynamic therapy (PDT) for treatment of facial port-wine stain (PWS) birthmarks in pediatric patients. Photodiagnosis Photodyn Ther 2014; 11:491-7. [DOI: 10.1016/j.pdpdt.2014.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/08/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
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Li D, Farshidi D, Wang G, He Y, Kelly K, Wu W, Chen B, Ying Z. A comparison of microvascular responses to visible and near-infrared lasers. Lasers Surg Med 2014; 46:479-87. [PMID: 24974953 PMCID: PMC4356526 DOI: 10.1002/lsm.22250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Pulsed dye laser (PDL) is a commonly used treatment for Port Wine Stain birthmarks (PWS). However, deeper components of PWS are often resistant to PDL. Deeper penetrating lasers, including the long pulsed Neodymium:Yttrium Aluminum Garnet (Nd:YAG) laser have been used, but carry greater risk. This study evaluates the distinct blood vessel thermal responses to visible (595 nm) and near infrared (1,064 nm) lasers using animal and numerical models. STUDY DESIGN/MATERIALS AND METHODS Blood vessels in the rodent dorsal skin chamber (DSC) were irradiated by a 595 nm PDL and a long-pulsed 1,064 nm Nd:YAG laser. Laser-induced immediate and 1-hour post-structural and functional changes in the vessels were documented. Numerical simulations were conducted using a 1,000 µm depth SD mouse skin fold to simulate experimental conditions. RESULTS PDL irradiation produced immediate blood vessel hemorrhage. Modeling indicated this occurs due to preferential heating of the superior parts of large blood vessels. Nd:YAG irradiation resulted in blood vessel constriction; modeling indicated more uniform heating of vessel walls. CONCLUSION PDL and Nd:YAG lasers result in distinct tissue responses. This supports different observable clinical treatment end points when using these devices. Vessel constriction associated with the Nd:YAG may be more difficult to observe and is one reason this device may carry greater risk.
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Affiliation(s)
- D. Li
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, China
| | - D. Farshidi
- Beckman Laser Institute, University of California, Irvine, California 92612
| | - G.X. Wang
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, China
- Department of Mechanical Engineering, The University of Akron, Akron, Ohio 44325-3903
| | - Y.L. He
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, China
| | - K.M. Kelly
- Beckman Laser Institute, University of California, Irvine, California 92612
| | - W.J. Wu
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, China
| | - B. Chen
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, China
| | - Z.X. Ying
- Laser Treatment Center, Department of Dermatology, Medical School, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, China
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Li D, Chen B, Wu WJ, Wang GX, He YL, Ying ZX. Experimental study on the vascular thermal response to visible laser pulses. Lasers Med Sci 2014; 30:135-45. [DOI: 10.1007/s10103-014-1631-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/03/2014] [Indexed: 11/29/2022]
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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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Li D, Wang GX, He YL, Kelly KM, Wu WJ, Wang YX, Ying ZX. A two-temperature model for selective photothermolysis laser treatment of port wine stains. APPLIED THERMAL ENGINEERING 2013; 59:41-51. [PMID: 25110458 PMCID: PMC4123555 DOI: 10.1016/j.applthermaleng.2013.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Selective photothermolysis is the basic principle for laser treatment of vascular malformations such as port wine stain birthmarks (PWS). During cutaneous laser surgery, blood inside blood vessels is heated due to selective absorption of laser energy, while the surrounding normal tissue is spared. As a result, the blood and the surrounding tissue experience a local thermodynamic non-equilibrium condition. Traditionally, the PWS laser treatment process was simulated by a discrete-blood-vessel model that simplifies blood vessels into parallel cylinders buried in a multi-layer skin model. In this paper, PWS skin is treated as a porous medium made of tissue matrix and blood in the dermis. A two-temperature model is constructed following the local thermal non-equilibrium theory of porous media. Both transient and steady heat conduction problems are solved in a unit cell for the interfacial heat transfer between blood vessels and the surrounding tissue to close the present two-temperature model. The present two-temperature model is validated by good agreement with those from the discrete-blood-vessel model. The characteristics of the present two-temperature model are further illustrated through a comparison with the previously-used homogenous model, in which a local thermodynamic equilibrium assumption between the blood and the surrounding tissue is employed.
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Affiliation(s)
- D Li
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - G X Wang
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
- Department of Mechanical Engineering, The University of Akron, Akron, Ohio, 44325-3903, USA
| | - Y L He
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - K M Kelly
- Beckman Laser Institute, University of California, Irvine, California, 92612, USA
| | - W J Wu
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - Y X Wang
- Laser Treatment Center, Department of Dermatology, Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - Z X Ying
- Laser Treatment Center, Department of Dermatology, Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
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Craig LM, Alster TS. Vascular Skin Lesions in Children: A Review of Laser Surgical and Medical Treatments. Dermatol Surg 2013; 39:1137-46. [DOI: 10.1111/dsu.12129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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[Therapeutic tools for port-wine stains]. Ann Dermatol Venereol 2013; 140:226-33; quiz 225, 234. [PMID: 23466161 DOI: 10.1016/j.annder.2012.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/14/2012] [Accepted: 12/13/2012] [Indexed: 11/24/2022]
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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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Zhou Y, Yin D, Xue P, Huang N, Qiu H, Wang Y, Zeng J, Ding Z, Gu Y. Imaging of skin microvessels with optical coherence tomography: potential uses in port wine stains. Exp Ther Med 2012; 4:1017-1021. [PMID: 23226766 PMCID: PMC3494129 DOI: 10.3892/etm.2012.711] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/06/2012] [Indexed: 11/21/2022] Open
Abstract
The knowledge of vascular structures of port wine stains (PWSs) may be useful to select treatment doses and improve therapeutic efficacy. Biopsies are impractical to implement, therefore, it is necessary to develop non-invasive techniques for morphological evaluation. This study aimed to evaluate the application of a novel optical coherence tomography (OCT) system to characterize the vascular structures of PWSs. First, OCT images were obtained from the skin of healthy rabbit ears and compared with the histopathological images. Second, OCT was used to document the differences between PWS lesions and contralateral normal skin; the size and depth of the vascular structures of two clinical types of PWSs were measured and statistically analyzed. The dermal blood vessels of healthy rabbit ears were clearly distinguished from other tissue. There was no statistical difference between the vascular diameter or depth measured by OCT images and histopathological sections (P>0.05). The OCT images of the PWSs could be distinguished from normal skin. There was no statistical difference in the depth of vessels between the purple-type and the proliferative-type PWSs (P>0.05), while there was statistical difference in the diameter of vessels between them (P<0.01). Therefore, OCT is a promising, real-time, in vivo and non-invasive tool with which to characterize the vascular structures of PWSs.
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Affiliation(s)
- Yang Zhou
- The Department of Laser Medicine, The PLA General Hospital, Beijing 100853
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Mazhar A, Sharif SA, Cuccia JD, Nelson JS, Kelly KM, Durkin AJ. Spatial frequency domain imaging of port wine stain biochemical composition in response to laser therapy: a pilot study. Lasers Surg Med 2012; 44:611-21. [PMID: 22911574 DOI: 10.1002/lsm.22067] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Objective methods to assess port wine stain (PWS) response to laser treatment have been the subject of various research efforts for several years. Herein, we present a pilot study using a newly developed, light emitting diode (LED) based spatial frequency domain imaging (SFDI) device to record quantitatively biochemical compositional changes in PWS after laser therapy. STUDY DESIGN/PATIENTS AND METHODS A SFDI system was used to image before, and after, five PWS treatment sessions [n = 4 subjects (one subject was imaged before and after two consecutive laser treatments)]. SFDI derived wide-field optical properties (absorption and scattering) and tissue chromophore concentrations including oxy-hemoglobin (ctO(2) Hb), deoxy-hemoglobin (ctHHb), total hemoglobin (ctTHb), and tissue oxygen saturation (stO(2) ) are presented for skin imaged prior to and immediately after laser treatment. The SFDI derived images were analyzed by comparing the above measurements in PWS to those of normal skin and tracking changes immediately after laser exposure. RESULTS Elevated oxy-hemoglobin (>20%) and tissue oxygen saturation (>5%) were measured in all PWS lesions and compared to values for normal skin prior to treatment. Laser treatment resulted in an increase in deoxy-hemoglobin (>100%), decrease in tissue oxygen saturation (>10%), and reduced scattering (>15%) in all PWS lesions. One subject was followed before and after two consecutive laser treatments and the overall improvement in PWS lesion blanching was quantitatively assessed by measuring a 45% decrease in dermal blood volume. CONCLUSION SFDI is a rapid non-contact wide-field optical technique that shows potential as an imaging device that can be used to quantify biochemical compositional changes in PWS after laser therapy. Future work will investigate the potential of SFDI to provide intra-operative guidance for laser therapy of PWS lesions on an individual patient basis.
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Affiliation(s)
- Amaan Mazhar
- Beckman Laser Institute, University of California, Irvine, California 92612, USA
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Surgical treatment of dermatomal capillary malformations in the adult face. Arch Plast Surg 2012; 39:126-9. [PMID: 22783511 PMCID: PMC3385324 DOI: 10.5999/aps.2012.39.2.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 01/31/2012] [Accepted: 02/02/2012] [Indexed: 11/24/2022] Open
Abstract
Background Facial capillary malformations (CMs) rarely recede; they often become darker and raised in proportion to their growth. These malformations may hypertrophy in adulthood, resulting in increased disfigurement and dysfunction. Laser treatment is considered a first-line therapy for focal CMs, but thick wide lesions, which are accompanied by hypertrophy and have a well-circumscribed nodularity, may be treated with surgical excision and reconstruction. Methods We retrospectively reviewed the records of 25 consecutive patients who had undergone complete or partial excisions of facial capillary malformations in our unit. After the excisions, the defects that encompassed their facial aesthetic units were subsequently covered by various methods, including primary closures, local flaps, expanded flaps, split-thickness skin grafts, and full thickness skin grafts. Results The data demonstrated satisfactory results and reliability. Our patients were treated without significant complications, and all of the patients were moderately or fully satisfied with the outcome of their surgeries. Conclusions Among the many reconstructive options for adult patients with facial capillary malformations, thick split-thickness skin grafts can be a good choice for the coverage of widely excised wounds.
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Laquer VT, Dao BM, Pavlis JM, Nguyen AN, Chen TS, Harris RM, Rugg EL, Kelly KM. Immunohistochemistry of angiogenesis mediators before and after pulsed dye laser treatment of angiomas. Lasers Surg Med 2012; 44:205-10. [PMID: 22302773 PMCID: PMC4106708 DOI: 10.1002/lsm.22005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Tissue effects of vascular lesion laser treatment are incompletely understood. Injury caused by pulsed dye laser (PDL) treatment may result in altered expression of mediators associated with angiogenesis. MATERIALS AND METHODS Eight human subjects had one angioma treated with PDL (7 mm, 1.5 millisecond pulse duration, 9 J/cm(2), cryogen spray cooling of 30 millisecond with a 30 millisecond delay). One week later, three biopsies were taken: normal skin, untreated angioma, angioma post-PDL. Tissue was frozen and sections processed for immunohistochemistry staining of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), matrix metalloproteinase 9 (MMP-9), and angiopoietin 2 (ANG-2). Images were graded in a blinded fashion by a board certified dermatopathologist. RESULTS There were no clear trends in VEGF expression in the epidermis, dermis, or endothelial cells. As compared to normal skin, angiomas demonstrated the following: bFGF was decreased in the epidermis; MMP-9 was decreased or unchanged in the epidermis and increased in the endothelial cells; ANG-2 was increased in the endothelial cells. When comparing normal skin to angiomas + PDL, bFGF was decreased in the epidermis and increased in the dermis; MMP-9 was decreased or unchanged in the epidermis; ANG-2 was again increased in the endothelial cells. Comparison of staining in angioma to angioma + PDL samples revealed increased dermal bFGF expression. CONCLUSION Alterations in angiogenesis mediators were noted after PDL. Angiogenesis mediator changes associated with PDL treatment differed from those previously reported for incisional biopsies. This pilot study can guide future work on laser-induced alterations in vascular lesions and such information may ultimately be used to optimize treatment outcomes.
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Affiliation(s)
- Vivian T Laquer
- Department of Dermatology, University of California, Irvine, Irvine, CA 92697, USA.
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Peters M, van Drooge A, Wolkerstorfer A, van Gemert M, van der Veen J, Bos J, Beek J. Double Pass 595 nm pulsed dye laser at a 6 minute interval for the treatment of port-wine stains is not more effective than single pass. Lasers Surg Med 2012; 44:199-204. [DOI: 10.1002/lsm.22011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2012] [Indexed: 11/09/2022]
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Chen JK, Ghasri P, Aguilar G, van Drooge AM, Wolkerstorfer A, Kelly KM, Heger M. An overview of clinical and experimental treatment modalities for port wine stains. J Am Acad Dermatol 2012; 67:289-304. [PMID: 22305042 DOI: 10.1016/j.jaad.2011.11.938] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 10/15/2011] [Accepted: 11/10/2011] [Indexed: 01/03/2023]
Abstract
Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy.
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Affiliation(s)
- Jennifer K Chen
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA
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50
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Tremaine AM, Armstrong J, Huang YC, Elkeeb L, Ortiz A, Harris R, Choi B, Kelly KM. Enhanced port-wine stain lightening achieved with combined treatment of selective photothermolysis and imiquimod. J Am Acad Dermatol 2012; 66:634-41. [PMID: 22244840 DOI: 10.1016/j.jaad.2011.11.958] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/16/2011] [Accepted: 11/20/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Pulsed dye laser (PDL) is the gold standard for treatment of port-wine stain (PWS) birthmarks but multiple treatments are required and complete resolution is often not achieved. Posttreatment vessel recurrence is thought to be a factor that limits efficacy of PDL treatment of PWS. Imiquimod 5% cream is an immunomodulator with antiangiogenic effects. OBJECTIVE We sought to determine if application of imiquimod 5% cream after PDL improves treatment outcome. METHODS Healthy individuals with PWS (n = 24) were treated with PDL and then randomized to apply posttreatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements (Commission Internationale de l'Eclairage L∗a∗b∗ colorspace) for 57 PWS sites (multiple sites per patient) were taken at baseline and compared with measurements taken 8 weeks posttreatment. The Δa∗ (change in erythema) and ΔE (difference in color between normal-appearing skin and PWS skin) were measured to quantify treatment outcome. RESULTS Two patients developed minor skin irritation. Other adverse effects were not noted. Average ∆a∗ was 0.43 for PDL + placebo sites (n = 25) and 1.27 for PDL + imiquimod sites (n = 32) (P value = .0294) indicating a greater reduction in erythema with imiquimod. Average ∆E was 2.59 for PDL + placebo and 4.08 for PDL + imiquimod (P value = .0363), again indicating a greater color improvement with imiquimod. LIMITATIONS Effects were evaluated after a single treatment and duration of effect is unknown. CONCLUSION Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy.
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Affiliation(s)
- Anne Marie Tremaine
- Beckman Laser Institute, University of California, Irvine, Irvine, California 92697-2400, USA.
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