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Huang X, Zheng S, Chen P, Zhu M, Guo J, Li Q, Zeng K, He S. Effective treatment of corticosteroid-induced facial erythema using fractional radiofrequency microneedling. Lasers Surg Med 2024; 56:466-473. [PMID: 38693708 DOI: 10.1002/lsm.23787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To investigate the efficacy of Fractional Radiofrequency Microneedling (FRM) in treating corticosteroid-induced facial erythema. METHODS A retrospective study was conducted involving eight patients diagnosed as corticosteroid-induced facial erythema. Each patient underwent a single session of FRM. Evaluative measures included Clinician's Erythema Assessment (CEA), Patient's Self-Assessment (PSA), assessment of telangiectasia severity, procedure-associated pain (10-point scale), patient satisfaction (3-point scale) and secondary outcomes. RESULTS The study found a 75% success rate and 100% effectiveness rate in alleviating erythema symptoms. CEA and PSA scores decreased by 67.7% and 78.1%, respectively. No cases of erythema rebound were recorded during the 3-month follow-up period. CONCLUSIONS FRM demonstrated effectiveness and safety in treating facial erythema, offering promising advancement in dermatologic therapeutics.
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Affiliation(s)
- Xiaowen Huang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siqi Zheng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Menghua Zhu
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jia Guo
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Li
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kang Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sijin He
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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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 B, Zhang Y, Lou Y, Hu X, Li F. Initial research on the effect and mechanism of Tivozanib on pulsed dye laser induced angiogenesis. Lasers Surg Med 2022; 54:1157-1166. [PMID: 35916102 DOI: 10.1002/lsm.23586] [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: 01/06/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Pulsed dye laser (PDL) is the main treatment for port wine stain (PWS), but a considerable number of patients show low clearances. The reason for the poor efficacy is related to PDL-induced angiogenesis. Vascular endothelial growth factor (VEGF) plays an important role in PDL-induced angiogenesis and can activate the tyrosine kinase activity of VEGF receptor (VEGFR) in endothelial cells. It triggers a full range of responses, and then participates in the regulation of angiogenesis. Tivozanib is an inhibitor of VEGFR tyrosine kinase activity, which can block the pro-angiogenic effect of VEGF and reduce vascular permeability. METHOD Different energy densities of PDL were used to irradiate the abdominal skin of rats. According to the general and pathological changes of the irradiated area, the energy density of 8 J/cm2 with smaller scab and stronger vascular effect was selected for follow-up experiments. Divided the rat abdomen skin into four areas, irradiated three of them uniformly with an energy density of 8 J/cm2 , and applied different concentrations of Tivozanib coating agent to the laser irradiation area, and grouped them as follows: (1) vacant group, (2) control group, (3) 0.5% Tivozanib group, (4) 1% Tivozanib group. Camera and dermoscopy were used to observe skin changes. Hematoxylin-eosin staining, immunohistochemical staining, and blood vessels were counted to detect dermal vascular regeneration. Transcriptome sequencing and real-time polymerase chain reaction (PCR) were conducted to elucidate the mechanism and validate the reliability. RESULTS The number of blood vessels in the 0.5% Tivozanib group and 1% Tivozanib group was significantly reduced on the 7, 10, and 14 days compared with the control group. The number of blood vessels in the 1% Tivozanib group was significantly reduced compared with the 0.5% Tivozanib group, indicating that Tivozanib successfully inhibited PDL-induced angiogenesis, and the inhibitory effect of 1% Tivozanib was more significant than that of 0.5% Tivozanib. Transcriptome sequencing results showed a total of 588 significantly differentially expressed genes, including 90 upregulated genes and 498 downregulated genes. Gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis showed that the significantly differentially expressed genes were mainly enriched in the metabolic pathways which were closely related to angiogenesis. Finally, real-time PCR was used to verify the genes with higher expression differences, the top ranking and closely related to angiogenesis, namely, Cxcl1, Cxcl2, Cxcl3, Cxcl6, Ccl3, Csf3, IL1β, iNOS, Mmp9, Mmp13, Plau, Ets1, Spp1, Nr4a1. The results were consistent with the trend of transcriptome sequencing results, which proved the reliability of this study. CONCLUSION This study explored the inhibitory effect of Tivozanib on PDL-induced angiogenesis, and provided a new idea for the treatment of clinical PWS. Transcriptome sequencing explored the mechanism and provided reliable clues for later in-depth research.
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Affiliation(s)
- Bing Wang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Yaqin Zhang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Yan Lou
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Xin Hu
- Department of Microbiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, P.R. China
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Wang B, Mei X, Wang Y, Hu X, Li F. Adjuncts to pulsed dye laser for treatment of port wine stains: a literature review. J COSMET LASER THER 2022; 23:209-217. [PMID: 35422188 DOI: 10.1080/14764172.2022.2052901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bing Wang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Xianglin Mei
- Department of Pathology, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Yanlong Wang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, P. R. China
| | - Xin Hu
- Department of Dermatology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, P. R. China
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, P. R. China
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Treating pediatric port-wine stains in aesthetics. Clin Dermatol 2022; 40:11-18. [DOI: 10.1016/j.clindermatol.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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7
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Wang M, Lin Y, Shi W, Chen X, Mi Z, Jia Z, Pan Q, Wang Z, Han J, Liu H. Topical metformin suppresses angiogenesis pathways induced by pulsed dye laser irradiation in animal models. Exp Dermatol 2021; 31:393-397. [PMID: 34564891 DOI: 10.1111/exd.14461] [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: 01/17/2021] [Revised: 08/11/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
Pulsed dye laser (PDL) is the first-line treatment for port-wine stain (PWS). However, only a small portion of the lesions could be completely cleared by PDL treatment, which might be related to the regeneration and revascularization of the vascular structures after laser irradiation. Recently, it is believed that the suppression of regeneration and revascularization of photocoagulated blood vessels can achieve a better therapeutic outcome. We use rabbit ear and SD rat as the animal models to investigate whether PDL-induced angiogenesis can be suppressed by topical metformin. Our results showed that topical application of metformin can effectively suppress the PDL-induced early stage of angiogenesis via inhibition of the AKT/mTOR/P70S6K pathway in animal models.
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Affiliation(s)
- Meiling Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Yan Lin
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Wenhao Shi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xuechao Chen
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zihao Mi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhiwei Jia
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Qing Pan
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhenzhen Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Han
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Huaxu Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
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Sodha P, Suggs A, Munavalli GS, Friedman PM. A Randomized Controlled Pilot Study: Combined 595-nm Pulsed Dye Laser Treatment and Oxymetazoline Hydrochloride Topical Cream Superior to Oxymetazoline Hydrochloride Cream for Erythematotelangiectatic Rosacea. Lasers Surg Med 2021; 53:1307-1315. [PMID: 34233378 PMCID: PMC9290736 DOI: 10.1002/lsm.23439] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/05/2021] [Accepted: 05/23/2021] [Indexed: 02/02/2023]
Abstract
Background and Objectives We evaluated if oxymetazoline therapy combined with 595‐nm pulsed dye laser (PDL) will be more beneficial than topical oxymetazoline alone for the improvement of erythematotelangiectatic rosacea. Study Design/Materials and Methods This was a randomized, controlled, prospective clinical trial approved by an independent Institutional Review Board, which enrolled 34 patients with moderate to severe clinical erythema (CEA) into a two‐arm study of PDL with concomitant oxymetazoline cream (Arm 1) and oxymetazoline cream alone (Arm 2). Patients in Arm 1 were treated with 3 monthly laser sessions, which were started after 1 month of topical oxymetazoline cream. Thirty subjects continued with the study, and 25 subjects (Arm 1: 14, Arm 2: 11) completed the 6‐month follow‐up. With photographic comparison to baseline images, efficacy endpoints were based on clinical on‐site grading by both the investigator and the patient, using the grading tools for CEA, Global Aesthetic Improvement (GAI) assessment, vessel size improvement, and subject self‐assessment. These scales were assessed at baseline and/or at each clinical follow‐up at 1, 2, 3, and 6 months. Subject satisfaction as well as post‐treatment immediate response and treatment‐associated pain scores were also evaluated. Results Statistically significant improvement in CEA was seen in both arms at the 1‐, 2‐, and 3‐month post‐baseline visits (P < 0.01). Only Arm 1 presented statistically significant improvement in CEA (P < 0.001) at 6 months post baseline with a mean score of 1.6 (almost clear‐mild) compared with 3.2 at baseline. Arm 1 showed significantly greater mean vessel size improvement at 3 months (P < 0.01) and 6 months (P < 0.05) post baseline compared to Arm 2. Significantly greater improvement (P < 0.05) in the investigator GAI score was reported at the 2‐ and 6‐month follow‐ups compared with Arm 2. Subject GAI scores showed statistically significant greater improvement in Arm 1 compared with Arm 2 at both the 3‐ and 6‐month follow‐ups (P < 0.01). There were no complications or long‐term effects associated with PDL or topical oxymetazoline treatments. Conclusion The prospective trial verifies a safe, enhanced clinical outcome with the combination of PDL therapy and topical oxymetazoline for the treatment of erythematotelangiectatic rosacea patients. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.
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Affiliation(s)
- Pooja Sodha
- Department of Dermatology, George Washington University, Washington, 20037, District of Columbia
| | - Amanda Suggs
- Department of Dermatology, Duke University Health System, Durham, North Carolina, 27710
| | - Girish S Munavalli
- Department of Dermatology, Duke University Health System, Durham, North Carolina, 27710.,Dermatology, Laser & Vein Specialists of the Carolinas, Charlotte, North Carolina, 28207.,Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Paul M Friedman
- Dermatology and Laser Surgery Center, Houston, Texas, 77030.,Department of Dermatology, University of Texas MD Anderson Cancer Center, University of Texas, McGovern Medical School, Houston, Texas.,Department of Dermatology, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas
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Kilmister EJ, Hansen L, Davis PF, Hall SRR, Tan ST. Cell Populations Expressing Stemness-Associated Markers in Vascular Anomalies. Front Surg 2021; 7:610758. [PMID: 33634164 PMCID: PMC7900499 DOI: 10.3389/fsurg.2020.610758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022] Open
Abstract
Treatment of vascular anomalies (VAs) is mostly empirical and, in many instances unsatisfactory, as the pathogeneses of these heterogeneous conditions remain largely unknown. There is emerging evidence of the presence of cell populations expressing stemness-associated markers within many types of vascular tumors and vascular malformations. The presence of these populations in VAs is supported, in part, by the observed clinical effect of the mTOR inhibitor, sirolimus, that regulates differentiation of embryonic stem cells (ESCs). The discovery of the central role of the renin-angiotensin system (RAS) in regulating stem cells in infantile hemangioma (IH) provides a plausible explanation for its spontaneous and accelerated involution induced by β-blockers and ACE inhibitors. Recent work on targeting IH stem cells by inhibiting the transcription factor SOX18 using the stereoisomer R(+) propranolol, independent of β-adrenergic blockade, opens up exciting opportunities for novel treatment of IH without the β-adrenergic blockade-related side effects. Gene mutations have been identified in several VAs, involving mainly the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways. Existing cancer therapies that target these pathways engenders the exciting possibility of repurposing these agents for challenging VAs, with early results demonstrating clinical efficacy. However, there are several shortcomings with this approach, including the treatment cost, side effects, emergence of treatment resistance and unknown long-term effects in young patients. The presence of populations expressing stemness-associated markers, including transcription factors involved in the generation of induced pluripotent stem cells (iPSCs), in different types of VAs, suggests the possible role of stem cell pathways in their pathogenesis. Components of the RAS are expressed by cell populations expressing stemness-associated markers in different types of VAs. The gene mutations affecting the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways interact with different components of the RAS, which may influence cell populations expressing stemness-associated markers within VAs. The potential of targeting these populations by manipulating the RAS using repurposed, low-cost and commonly available oral medications, warrants further investigation. This review presents the accumulating evidence demonstrating the presence of stemness-associated markers in VAs, their expression of the RAS, and their interaction with gene mutations affecting the PI3K/AKT/mTOR and/or the Ras/RAF/MEK/ERK pathways, in the pathogenesis of VAs.
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Affiliation(s)
| | - Lauren Hansen
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | - Paul F. Davis
- Gillies McIndoe Research Institute, Wellington, New Zealand
| | | | - Swee T. Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand
- Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
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Fallahi M, Hallaji Z, Tavakolpour S, Niknam S, Salehi Farid A, Nili A, Teimourpour A, Daneshpazhooh M, Rahmati J, Haddady Abianeh S, Mahmoudi H. Evaluating the efficacy and safety of topical sirolimus 0.2% cream as adjuvant therapy with pulsed dye laser for the treatment of port wine stain: A randomized, double-blind, placebo-controlled trial. J Cosmet Dermatol 2020; 20:2498-2506. [PMID: 33251650 DOI: 10.1111/jocd.13867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Port Wine Stain (PWS) is a congenital capillary malformation. Although multiple treatments are required, the gold standard treatment for PWS is Pulsed Dye Laser (PDL). Given its anti-angiogenic effects, sirolimus can be considered as an adjuvant to PDL in PWS. AIM To evaluate the efficacy and safety of topical sirolimus (Rapamycin) 0.2% cream as adjuvant therapy for PDL for PWS. METHODS In this randomized double-blind placebo-controlled trial, 15 patients with PWS were enrolled. Each lesion was divided into upper and lower parts, and each part was assigned randomly to receive PDL (4 sessions, 2 months apart) plus sirolimus vs PDL and placebo. The response was evaluated using colorimetry, investigator global assessment (IGA), and patient global assessment (PGA) every two months for eight continuous months. RESULTS According to the colorimetric analysis, medial and lateral sides of the treatment and placebo parts did not differ significantly (both P-value > .05). However, according to PGA and IGA, there was a significant difference in favor of sirolimus (P-values = .041 and .039, respectively). Itching and dryness (86.7%), contact dermatitis (20%) were the most common adverse effects in the sirolimus group, while none of them were observed in placebo. CONCLUSION Although the improvement was significant subjectively, topical sirolimus 0.2% as an adjuvant to PDL does not appear to improve PWS erythema using calorimetric assessment.
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Affiliation(s)
- Mahsa Fallahi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Arak University of Medical Sciences, Arak, Iran
| | - Zahra Hallaji
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Somayeh Niknam
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Teimourpour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Tehran, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Rahmati
- Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital and Razi Hospital, Tehran University of Medical Sciences Tehran, Tehran, Iran
| | - Shahriar Haddady Abianeh
- Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital and Razi Hospital, Tehran University of Medical Sciences Tehran, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Artzi O, Mehrabi JN, Heyman L, Friedman O, Mashiah J. Treatment of port wine stain with
Tixel
‐induced rapamycin delivery following pulsed dye laser application. Dermatol Ther 2019; 33:e13172. [DOI: 10.1111/dth.13172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 11/09/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ofir Artzi
- Artzi Treatment and Research Center Tel Aviv Israel
- Department of DermatologyTel Aviv Sourasky Medical Center Tel Aviv Israel
| | | | - Lee Heyman
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Or Friedman
- Plastic Reconstructive Surgery DepartmentTel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Jacob Mashiah
- Department of DermatologyTel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
- Pediatric Dermatology Clinic, Dana‐Dwek Children's HospitalTel Aviv Sourasky Medical Center Tel Aviv Israel
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Fu Z, Huang J, Xiang Y, Huang J, Tang Z, Chen J, Nelson JS, Tan W, Lu J. Characterization of Laser‐Resistant Port Wine Stain Blood Vessels UsingIn VivoReflectance Confocal Microscopy. Lasers Surg Med 2019; 51:841-849. [DOI: 10.1002/lsm.23134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Zhibing Fu
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Jinhua Huang
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Yaping Xiang
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Jian Huang
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Zhen Tang
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - Jing Chen
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
| | - J. Stuart Nelson
- Department of Surgery, Beckman Laser Institute and Medical ClinicUniversity of California Irvine California 92617
| | - Wenbin Tan
- Department of Surgery, Beckman Laser Institute and Medical ClinicUniversity of California Irvine California 92617
- Department of Cell Biology and AnatomyUniversity of South Carolina School of Medicine Columbia South Carolina 29208
| | - Jianyun Lu
- Department of Dermatology, Third Xiangya HospitalCentral South University Changsha Hunan 410013 China
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The Pathogenesis of Port Wine Stain and Sturge Weber Syndrome: Complex Interactions between Genetic Alterations and Aberrant MAPK and PI3K Activation. Int J Mol Sci 2019; 20:ijms20092243. [PMID: 31067686 PMCID: PMC6539103 DOI: 10.3390/ijms20092243] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
Abstract
Port wine stain (PWS) is a congenital vascular malformation involving human skin. Approximately 15-20% of children a facial PWS involving the ophthalmic (V1) trigeminal dermatome are at risk for Sturge Weber syndrome (SWS), a neurocutaneous disorder with vascular malformations in the cerebral cortex on the same side of the facial PWS lesions. Recently, evidence has surfaced that advanced our understanding of the pathogenesis of PWS/SWS, including discoveries of somatic genetic mutations (GNAQ, PI3K), MAPK and PI3K aberrant activations, and molecular phenotypes of PWS endothelial cells. In this review, we summarize current knowledge on the etiology and pathology of PWS/SWS based on evidence that the activation of MAPK and/or PI3K contributes to the malformations, as well as potential futuristic treatment approaches targeting these aberrantly dysregulated signaling pathways. Current data support that: (1) PWS is a multifactorial malformation involving the entire physiological structure of human skin; (2) PWS should be pathoanatomically re-defined as "a malformation resulting from differentiation-impaired endothelial cells with a progressive dilatation of immature venule-like vasculatures"; (3) dysregulation of vascular MAPK and/or PI3K signaling during human embryonic development plays a part in the pathogenesis and progression of PWS/SWS; and (4) sporadic low frequency somatic mutations, such as GNAQ, PI3K, work as team players but not as a lone wolf, contributing to the development of vascular phenotypes. We also address many crucial questions yet to be answered in the future research investigations.
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van Raath MI, van Amesfoort JE, Hermann M, Ince Y, Zwart MJ, Echague AV, Chen Y, Ding B, Huang X, Storm G, Heger M. Site-specific pharmaco-laser therapy: A novel treatment modality for refractory port wine stains. J Clin Transl Res 2019; 5:1-24. [PMID: 31579838 PMCID: PMC6765152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/29/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022] Open
Abstract
Despite extensive efforts to optimize laser therapy, i.e., the current gold standard treatment, a majority of port wine stain (PWS) patients responds suboptimally to laser therapy. This paper describes the niceties of a novel PWS treatment modality termed site-specific pharmaco-laser therapy (SSPLT). In contrast to the classic approach of enhancing the extent of intravascular photocoagulation (the photothermal response), SSPLT focuses on optimization of post-irradiation thrombus formation (i.e., the hemodynamic response) by combining conventional laser therapy with the administration of thermosensitive drug delivery systems that encapsulate prothrombotic and antifibrinolytic drugs. The aim of SSPLT is to instill complete lumenal occlusion in target vessels, which has been linked to optimal PWS blanching. RELEVANCE FOR PATIENTS The current treatment options for PWS patients are limited in efficacy. Novel therapeutic modalities are needed to more effectively treat patients with recalcitrant PWSs. SSPLT is an experimental-stage treatment modality that could serve as an adjuvant to pulsed dye laser therapy for a selected group of patients whose PWS is ill-responsive to standard treatment. The expected clinical result of SSPLT is improved lesional blanching.
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Affiliation(s)
- M. Ingmar van Raath
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China,2Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Martin Hermann
- 3Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Yasin Ince
- 2Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maurice J. Zwart
- 2Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Agustina V. Echague
- 4Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yan Chen
- 5Department of Clinical Medicine, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
| | - Baoyue Ding
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
| | - Xuan Huang
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China
| | - Gert Storm
- 6Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands,7Department of Controlled Drug Delivery, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Michal Heger
- 1Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China,6Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands,Corresponding author: Michal Heger Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, PR China Tel: +86-138-19345926.
Department of Pharmaceutics, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands Tel: +31-30-2533966.
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15
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Alegre-Sánchez A, Boixeda P. RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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16
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Yin R, Rice SJ, Wang J, Gao L, Tsai J, Anvari RT, Zhou F, Liu X, Wang G, Tang Y, Mihm MC, Belani CP, Chen DB, Nelson JS, Tan W. Membrane trafficking and exocytosis are upregulated in port wine stain blood vessels. Histol Histopathol 2018; 34:479-490. [PMID: 30302745 DOI: 10.14670/hh-18-051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Port wine stain (PWS) is characterized as a progressive dilatation of immature venule-like vasculatures which result from differentiation-impaired endothelial cells. In this study, we aimed to identify the major biological pathways accounting for the pathogenesis of PWS. METHODS Sequential windowed acquisition of all theoretical fragment ion mass spectra (SWATH-MS) was used to identify differentially expressed proteins in PWS lesions, followed by confirmative studies with immunohistochemistry, immunoblot and transmission electron microscopy (TEM). RESULTS 107 out of 299 identified proteins showed differential expressions in PWS lesions as compared to normal skin, mainly involving the functions of biosynthesis, membrane trafficking, cytoskeleton and cell adhesion/migration. The confirmative studies showed that expressions of membrane trafficking/exocytosis related proteins such as VAT1, IQGAP1, HSC70, clathrin, perlecan, spectrin α1 and GDIR1 were significantly increased in PWS blood vessels as compared to normal ones; while collagen subtypes 6A1 and 6A3 were decreased in PWS skin. Furthermore, TEM studies showed there is a significant upregulation of extracellular vesicle exocytosis from PWS blood vessels as compared to control. CONCLUSIONS The biological process of membrane trafficking and exocytosis is enhanced in PWS blood vessels. Our results imply that the extracellular vesicles released by lesional endothelial cells may act as potential intercellular signaling mediators to contribute to the pathogenesis of PWS.
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Affiliation(s)
- Rong Yin
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina, USA.,Department of Dermatology, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | | | - Jinwei Wang
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Urology, the Xiangya 3rd Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Lin Gao
- Department of Dermatology, Xijing Hospital, Xi'an, China
| | - Joseph Tsai
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA
| | - Radean T Anvari
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA
| | - Fang Zhou
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Urology, the Xiangya 3rd Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Xin Liu
- Penn State Cancer Institute, Hershey, PA, USA
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Xi'an, China
| | - Yuxin Tang
- Department of Urology, the Xiangya 3rd Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Martin C Mihm
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chandra P Belani
- Penn State Cancer Institute, Hershey, PA, USA.,Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Dong-Bao Chen
- Department of Obstetrics and Gynecology, University of California, Irvine, California, USA
| | - J Stuart Nelson
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Biomedical Engineering, University of California, Irvine, California, USA
| | - Wenbin Tan
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA.,Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
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17
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Topical Adjuncts to Pulsed Dye Laser for Treatment of Port Wine Stains: Review of the Literature. Dermatol Surg 2018; 44:796-802. [PMID: 29799824 DOI: 10.1097/dss.0000000000001507] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Port wine stains (PWS) pose a therapeutic challenge. Pulsed dye laser (PDL) is the treatment of choice; however, treatment is often ineffective and recurrences are common. OBJECTIVE This article provides a review of topical therapies that have been investigated to improve efficacy of PDL for the treatment of PWS. MATERIALS AND METHODS A literature search was performed through PubMed, EMBASE, Web of Science, and CINAHL, using the search terms "port wine stain," "pulsed dye laser," and "topical." RESULTS Clinical trials have investigated the topical agents, timolol, imiquimod, and rapamycin (RPM) in combination with PDL for the treatment of PWS. Topical timolol with PDL failed to show improved efficacy compared with PDL alone. Two clinical trials using imiquimod and PDL showed enhanced blanching of PWS compared with controls. Rapamycin and PDL were more effective than controls for facial PWS, but not for nonfacial PWS. CONCLUSION Topical imiquimod and RPM have shown some efficacy in treating PWS with PDL, but to date there is no topical adjuvant to PDL that reliably improves results for PWS.
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18
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Abstract
Port wine stain (PWS) is a congenital, progressive vascular malformation. Many patients with PWS develop hypertrophy and discrete nodularity during their adult life, but the mechanism(s) remain incompletely understood. In this study, we attempted to investigate activation status of PKCα, PI3K, PDPK1 and PLC-γ and protein levels of PP2A and DAG to explore their potential roles in the formation of hypertrophic and nodular PWS lesions. We found phosphorylated levels of PKCα, PI3K, PDPK1, and PLC-γ and protein levels of PP2A and DAG showed moderate increases in the endothelial cells of hypertrophic PWS as compared to the adjacent normal skin. These increases extended throughout the entire stroma of blood vessels in PWS nodules. Many proliferating cells, such as fibroblasts, also showed strong activation of PKCα, PI3K, PDPK1 and PLC-γ and upregulations of PP2A and DAG in nodular PWS lesions. Our data showed that there is aberrant activation of PKCα, PI3K, PDPK1 and PLC-γ and upregulation of PP2A and DAG mainly in endothelial cells in hypertrophic PWS areas, but presenting in the entire vasculatures and surrounding fibroblasts in PWS nodules. Our data suggest that both PKCα and PI3K signaling pathways contribute to the development of hypertrophy and nodularity in adult PWS.
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19
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Alegre-Sánchez A, Boixeda P. RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:915-916. [PMID: 29636196 DOI: 10.1016/j.ad.2017.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/31/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- A Alegre-Sánchez
- Unidad de Láser, Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, España.
| | - P Boixeda
- Unidad de Láser, Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, España
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20
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Tan W, Wang J, Zhou F, Gao L, Yin R, Liu H, Sukanthanag A, Wang G, Mihm MC, Chen DB, Nelson JS. Coexistence of Eph receptor B1 and ephrin B2 in port-wine stain endothelial progenitor cells contributes to clinicopathological vasculature dilatation. Br J Dermatol 2017; 177:1601-1611. [PMID: 28599054 DOI: 10.1111/bjd.15716] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Port-wine stain (PWS) is a vascular malformation characterized by progressive dilatation of postcapillary venules, but the molecular pathogenesis remains obscure. OBJECTIVES To illustrate that PWS endothelial cells (ECs) present a unique molecular phenotype that leads to pathoanatomical PWS vasculatures. METHODS Immunohistochemistry and transmission electron microscopy were used to characterize the ultrastructure and molecular phenotypes of PWS blood vessels. Primary culture of human dermal microvascular endothelial cells and in vitro tube formation assay were used for confirmative functional studies. RESULTS Multiple clinicopathological features of PWS blood vessels during the development and progression of the disease were shown. There were no normal arterioles and venules observed phenotypically and morphologically in PWS skin; arterioles and venules both showed differentiation impairments, resulting in a reduction of arteriole-like vasculatures and defects in capillary loop formation in PWS lesions. PWS ECs showed stemness properties with expression of endothelial progenitor cell markers CD133 and CD166 in non-nodular lesions. They also expressed dual venous/arterial identities, Eph receptor B1 (EphB1) and ephrin B2 (EfnB2). Co-expression of EphB1 and EfnB2 in normal human dermal microvascular ECs led to the formation of PWS-like vasculatures in vitro, for example larger-diameter and thick-walled capillaries. CONCLUSIONS PWS ECs are differentiation-impaired, late-stage endothelial progenitor cells with a specific phenotype of CD133+ /CD166+ /EphB1+ /EfnB2+ , which form immature venule-like pathoanatomical vasculatures. The disruption of normal EC-EC interactions by coexistence of EphB1 and EfnB2 contributes to progressive dilatation of PWS vasculatures.
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Affiliation(s)
- W Tan
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A
| | - J Wang
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,The Third Xiangya Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, 412000, China
| | - F Zhou
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,The Third Xiangya Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, 412000, China
| | - L Gao
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - R Yin
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,Department of Dermatology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - H Liu
- Shandong Provincial Institute of Dermatology and Venereology, Jinan, Shandong, 250022, China
| | - A Sukanthanag
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A
| | - G Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - M C Mihm
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, U.S.A
| | - D-B Chen
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, CA, U.S.A
| | - J S Nelson
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, U.S.A
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21
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Gao L, Yin R, Wang H, Guo W, Song W, Nelson JS, Tan W, Wang G. Ultrastructural characterization of hyperactive endothelial cells, pericytes and fibroblasts in hypertrophic and nodular port-wine stain lesions. Br J Dermatol 2017; 177:e105-e108. [PMID: 28182251 DOI: 10.1111/bjd.15373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - R Yin
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.,Department of Dermatology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - H Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - W Guo
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - W Song
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - J S Nelson
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA, 92617, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, CA, 92617, U.S.A
| | - W Tan
- Department of Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA, 92617, U.S.A
| | - G Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
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22
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Rahimi H, Hassannejad H, Moravvej H. Successful Treatment of Unilateral Klippel-Trenaunay Syndrome With Pulsed-Dye Laser in a 2-Week Old Infant. J Lasers Med Sci 2017; 8:98-100. [PMID: 28652904 DOI: 10.15171/jlms.2017.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Klippel-Trenaunay syndrome (KTS) is a rare congenital mesodermal abnormality characterized by varicose veins, cutaneous capillary malformation, as well as bone and soft tissue hypertrophy. Case Report: A 2-week-old female infant presented to our clinic because of vascular nevus and progressive enlargement of her right extremities and trunk since birth. The patient was treated with 595-nm pulsed-dye laser (PDL). Her port-wine stain (PWS) disappeared completely after third PDL session and the soft tissue hypertrophy stopped. The patient experienced neither recurrence nor any change in size after 7 years of follow up. Conclusion: PDL can treat KTS completely with no reccurence if it is used in "early stage" of disease.
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Affiliation(s)
- Hoda Rahimi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Hassannejad
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Moravvej
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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23
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Doh EJ, Ohn J, Kim MJ, Kim YG, Cho S. Prospective pilot study on combined use of pulsed dye laser and 1% topical rapamycin for treatment of nonfacial cutaneous capillary malformation. J DERMATOL TREAT 2017; 28:672-677. [DOI: 10.1080/09546634.2017.1306018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Eun Jin Doh
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jungyoon Ohn
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Min Ji Kim
- Department of Dermatology, Mapo-Gongdeok S&U Dermatology Clinic, Seoul, Korea
| | - Young Gull Kim
- Department of Dermatology, Mapo-Gongdeok S&U Dermatology Clinic, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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24
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Castelo-Soccio L, McMahon P. Pediatric Dermatology. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2017; 10:S8-S15. [PMID: 28360970 PMCID: PMC5367868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Skin changes are common in children. Common concerns are birthmarks (e.g., hemangiomas and port wine stains), atopic and contact dermatitis, acne, and alopecia areata. The authors review advances in common and not so common skin changes in pediatric patients.
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Affiliation(s)
- Leslie Castelo-Soccio
- The Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Patrick McMahon
- The Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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25
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Greveling K, Prens EP, van Doorn MB. Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)-A randomized controlled trial. Lasers Surg Med 2016; 49:104-109. [DOI: 10.1002/lsm.22548] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Karin Greveling
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; 3015 CA Rotterdam The Netherlands
| | - Errol P. Prens
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; 3015 CA Rotterdam The Netherlands
| | - Martijn B. van Doorn
- Department of Dermatology; Erasmus MC University Medical Center Rotterdam; 3015 CA Rotterdam The Netherlands
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26
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The Development of Hypertrophy in Port-Wine Stains, a Common Phenomenon that Affects Treatment Recommendations. Dermatol Surg 2015; 41:1246-8. [PMID: 26506068 DOI: 10.1097/dss.0000000000000524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Griffin TD, Foshee JP, Finney R, Saedi N. Port wine stain treated with a combination of pulsed dye laser and topical rapamycin ointment. Lasers Surg Med 2015; 48:193-6. [DOI: 10.1002/lsm.22436] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Thomas D. Griffin
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia Philadelphia 19107
| | - James P. Foshee
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia Philadelphia 19107
| | - Robert Finney
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia Philadelphia 19107
| | - Nazanin Saedi
- Department of Dermatology and Cutaneous Biology; Thomas Jefferson University Hospital; Philadelphia Philadelphia 19107
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28
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Abstract
Port-wine stains are a type of capillary malformation affecting 0.3% to 0.5% of the population. Port-wine stains present at birth as pink to erythematous patches on the skin and/or mucosa. Without treatment, the patches typically darken with age and may eventually develop nodular thickening or associated pyogenic granuloma. Laser and light treatments provide improvement through selective destruction of vasculature. A variety of vascular-selective lasers may be employed, with the pulsed dye laser being the most common and well studied. Early treatment produces more optimal results. Advances in imaging and laser treatment technologies demonstrate potential to further improve clinical outcomes.
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Affiliation(s)
| | - Roy G Geronemus
- Laser and Skin Surgery Center of New York, New York, NY, USA
| | - Kavitha K Reddy
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
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