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Bajaj S, Tao J, Hashemi DA, Geronemus RG. Weekly Pulsed Dye Laser Treatments for Port-Wine Birthmarks in Infants. JAMA Dermatol 2024; 160:606-611. [PMID: 38630490 PMCID: PMC11024797 DOI: 10.1001/jamadermatol.2024.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/30/2024] [Indexed: 04/20/2024]
Abstract
Importance Early treatment of port-wine birthmark (PWB) can be life-altering and is often associated with improved outcomes and quality of life. There is growing evidence that shorter treatment intervals may play a role in more rapid PWB clearance; however, the optimal treatment interval has not been established. Objective To describe the outcomes of once-weekly pulsed dye laser (PDL) treatments for PWB in infants. Design, Setting, and Participants This case series analyzed the medical records of patients with PWB who received once-weekly PDL treatments between January 1, 2022, and December 31, 2023, at the Laser & Skin Surgery Center of New York. These patients were younger than 6 months. Before-and-after treatment photographs were independently assessed and graded 2 months after initiation of treatment. Intervention Once-weekly PDL treatments. Main Outcomes and Measures The primary outcome was the percentage improvement of PWB, which was graded using the following scale: 0% (no improvement), 1% to 25% (mild improvement), 26% to 50% (moderate improvement), 51% to 75% (marked improvement), 76% to 95% (near-total clearance), and 96% to 100% (total clearance). Results Of the 10 patients (6 males [60%]; median [range] age at first treatment, 4 [<1 to 20] weeks) included, 7 (70%) had experienced either near-total clearance (76%-95%) or total clearance (96%-100%) of their PWB with once-weekly PDL treatments after 2 months. The other 3 patients all saw marked improvement (51%-75%) and subsequently went on to achieve near-total clearance with additional treatments. The median (range) duration of treatment and number of treatments to achieve near-total or total clearance in all patients were 2 (0.2-5.1) months and 8 (2-20) treatments, respectively. No adverse events were noted. Conclusion and Relevance This case series found that once-weekly PDL treatments for PWB in the first few months of life was associated with near-total or total clearance of PWB with no reported adverse events, suggesting improved outcomes can be achieved with shorter overall treatment duration. Further investigation into this novel decreased treatment interval of 1 week is warranted.
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Affiliation(s)
- Shirin Bajaj
- Laser & Skin Surgery Center of New York, New York
- The Ronald O. Perelman Department of Dermatology at New York University Langone Health, New York
| | - Joy Tao
- Laser & Skin Surgery Center of New York, New York
| | | | - Roy G. Geronemus
- Laser & Skin Surgery Center of New York, New York
- The Ronald O. Perelman Department of Dermatology at New York University Langone Health, New York
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2
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Yang L, Liu D, Liu L, Jiang X. Photodynamic effect of vascular-targeted polyphenol nanoparticles on Endothelial cells. Photodiagnosis Photodyn Ther 2024; 47:104096. [PMID: 38643893 DOI: 10.1016/j.pdpdt.2024.104096] [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: 10/31/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Port wine stains (PWS) are vascular malformations, and photodynamic therapy (PDT) is a promising treatment. Emerging drug delivery methods employ nanoparticles (NPs) to enhance drug permeability and retention in diseased blood vessels and improve drug bioavailability. (-) -epigallocatechin-3-gallate glycine (EGCG) has anti-angiogenetic effects and boosts photodynamic therapy. Chlorin e6 (Ce6) is capable of efficiently producing singlet oxygen, rendering it a very promising photosensitizer for utilization in nanomedicine. MATERIAL AND METHODS EGCG-Ce6-NPs were synthesized and characterized using various techniques. The photodynamic effects of EGCG-Ce6-NPs on endothelial cells were evaluated. The compatibility and toxicity of the nanoparticle was tested using the CCK-8 assay. The intracellular uptake of the nanoparticle was observed using an inverted fluorescence microscope, and the intracellular fluorescence intensity was detected using flow cytometry. The ROS generation and apoptosis induced by EGCG-Ce6-NPs was observed using confocal laser scanning microscopy and flow cytometry respectively. RESULTS EGCG-Ce6-NPs exhibited stability, spherical shape of uniform size while reducing the particle diameter, low polydisperse profile and retaining the ability to effectively generate singlet oxygen. These characteristics suggest promising potential for enhancing drug permeability and retention. Additionally, EGCG-Ce6-NPs demonstrated good compatibility with endothelial cells and enhanced intracellular uptake of Ce6. Furthermore, EGCG-Ce6-NPs increased activation efficiency, induced significant toxicity, more reactive oxygen species, and a higher rate of late apoptosis after laser irradiation. CONCLUSION This in vitro study showed the potentials EGCG-Ce6-NPs for the destruction of endothelial cells in vasculature.
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Affiliation(s)
- Lihua Yang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu 610041, PR China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Danni Liu
- Engineering Research Center in Biomaterials and National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, PR China
| | - Lian Liu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu 610041, PR China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu 610041, PR China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, PR China.
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3
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Foster M, Roy A, Kumar G. Large birth mark and unilateral swelling of the lower extremity in a young teenager. BMJ Case Rep 2024; 17:e258892. [PMID: 38702071 PMCID: PMC11085769 DOI: 10.1136/bcr-2023-258892] [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] [Indexed: 05/06/2024] Open
Abstract
We describe an early adolescent male who was diagnosed with vascular malformation associated with unilateral limb overgrowth based on the clinical findings of a persistent port-wine stain since birth and gradually progressing right lower limb oedema since early childhood. Clinicians should keep in mind to clinically evaluate such malformations in detail, as well as contemplate genetic testing in patients presenting with a large port-wine stain at birth, particularly if well demarcated and lateral in a lower extremity.
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Affiliation(s)
- Michael Foster
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Aparna Roy
- Paediatrics, Case Western Reserve University Hospital, Cleveland, Ohio, USA
| | - Gurinder Kumar
- Paediatrics, Case Western Reserve University Hospital, Cleveland, Ohio, USA
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4
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Mattheis S, Wanke I. Interdisciplinary Management of Vascular Anomalies in the Head and Neck. Laryngorhinootologie 2024; 103:S125-S147. [PMID: 38697145 DOI: 10.1055/a-2225-9932] [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: 05/04/2024]
Abstract
Vascular anomalies in the head and neck area are usually rare diseases and pose a particular diagnostic and therapeutic challenge. They are divided into vascular tumours and vascular malformations. A distinction is made between benign tumours, such as infantile haemangioma, and rare malignant tumours, such as angiosarcoma. Vascular malformations are categorised as simple malformations, mixed malformations, large vessel anomalies and those associated with other anomalies. Treatment is interdisciplinary and various modalities are available. These include clinical observation, sclerotherapy, embolisation, ablative and coagulating procedures, surgical resection and systemic drug therapy. Treatment is challenging, as vascular anomalies in the head and neck region practically always affect function and aesthetics. A better understanding of the genetic and molecular biological basis of vascular anomalies has recently led to clinical research into targeted drug therapies. This article provides an up-to-date overview of the diagnosis, clinic and treatment of vascular anomalies in the head and neck region.
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Affiliation(s)
- Stefan Mattheis
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Essen (Direktor: Prof. Dr. Stephan Lang)
| | - Isabel Wanke
- Zentrum für Neuroradiologie, Klinik Hirslanden, Zürich, Schweiz
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5
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Ryu JY, Chang YJ, Lee JS, Choi KY, Yang JD, Lee SJ, Lee J, Huh S, Kim JY, Chung HY. A nationwide cohort study on incidence and mortality associated with extracranial vascular malformations. Sci Rep 2023; 13:13950. [PMID: 37626114 PMCID: PMC10457363 DOI: 10.1038/s41598-023-41278-z] [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: 02/11/2023] [Accepted: 08/24/2023] [Indexed: 08/27/2023] Open
Abstract
Extracranial vascular malformations are abnormal formations of blood vessels located outside the brain (extracranial) that develop during fetal development. They are caused by errors in the formation of blood vessels in the embryo and can affect various parts of the body, such as the head, neck, face, and other regions. Some malformations may be asymptomatic and only require monitoring, while others may cause significant health issues or cosmetic concerns and may need medical intervention. There are very few studies have investigated the nationwide incidence and quantitative mortality of vascular malformations in terms of their subtypes. Thus, this study aimed to determine the nationwide incidence and mortality associated with vascular malformations. This nationwide population-based study evaluated 70,517 patients with vascular malformations from 2008 to 2021. We evaluated the incidence and mortality associated with each subtype of vascular malformation. Furthermore, Cox regression analysis was used to evaluate the association between vascular malformation and mortality. The annual incidence (per 100,000 population) of overall vascular, venous, capillary, arteriovenous, and lymphatic malformations was 9.85, 1.48, 2.31, 0.24, and 5.82 cases, respectively. Patients with vascular malformations, except those with venous malformations, had higher mortality than the matched controls. Moreover, among the vascular malformation subgroups, the adjusted hazard ratio of mortality was the highest for arteriovenous malformations. This study revealed that the overall annual incidence of vascular malformations was 9.85 cases per 100,000 population in Korea from 2008 to 2021. The mortality of the matched general population was lower than that of patients with vascular malformations, except for those with venous malformations. Additionally, the adjusted hazard ratio for mortality associated with arteriovenous malformations was the highest among the vascular malformation subgroups.
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Affiliation(s)
- Jeong Yeop Ryu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Yong June Chang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Kang Young Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea
| | - Seok-Jong Lee
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jongmin Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosanro, Jung-gu, Daegu, 41405, Republic of Korea.
- Cell and Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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6
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Colletti G, Negrello S, Rozell-Shannon L, Levitin GM, Colletti L, Chiarini L, Anesi A, Di Bartolomeo M, Pellacani A, Nocini R. Surgery for Port-Wine Stains: A Systematic Review. J Pers Med 2023; 13:1058. [PMID: 37511671 PMCID: PMC10381445 DOI: 10.3390/jpm13071058] [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: 04/30/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Port-wine stains (PWS) are congenital low-flow vascular malformations of the skin. PWS tend to become thicker and darker with time. Laser therapy is the gold standard and the first-line therapy for treating PWS. However, some resistant PWS, or PWS that have tissue hypertrophy, do not respond to this therapy. Our aim is to evaluate the role of surgery in the treatment of PWS birthmarks. METHODS A literature search was performed in PubMed, Scopus, Web of Science (WOS) and Google Scholar for all papers dealing with surgery for port-wine stains, from January 2010 to December 2020 using the search strings: (capillary vascular malformation OR port-wine stains OR Sturge Weber Syndrome OR sws OR pws) AND (surgical OR surgery). RESULTS Ten articles were identified and used for analysis. They were almost all case series with a short follow up period and lacked an objective-systematic score of evaluation. CONCLUSIONS Delay in treatment of port wine stains may result in soft tissue and bone hypertrophy or nodules with disfiguring or destructive characteristics. The correction of PWS-related facial asymmetry often requires bone surgery followed by soft tissue corrections to achieve a more harmonious, predictable result.
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Affiliation(s)
- Giacomo Colletti
- The Vascular Birthmark Foundation, P.O. Box 106, Latham, NY 12110, USA
- Department of Medical and Surgical Sciences for Children & Adults, Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo 71, 41124 Modena, Italy
| | - Sara Negrello
- Cranio-Maxillo-Facial Surgery Unit, University Hospital of Modena, 41124 Modena, Italy
| | | | - Gregory M Levitin
- The Vascular Birthmark Foundation, P.O. Box 106, Latham, NY 12110, USA
| | - Liliana Colletti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Luigi Chiarini
- Department of Medical and Surgical Sciences for Children & Adults, Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo 71, 41124 Modena, Italy
| | - Alexandre Anesi
- Department of Medical and Surgical Sciences for Children & Adults, Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo 71, 41124 Modena, Italy
| | - Mattia Di Bartolomeo
- Surgery, Dentistry, Maternity and Infant Department, Unit of Dentistry and Maxillo-Facial Surgery, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Arrigo Pellacani
- Surgery, Dentistry, Maternity and Infant Department, Unit of Dentistry and Maxillo-Facial Surgery, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Riccardo Nocini
- Section of Ear Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy
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7
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Kopecky A, Rokohl AC, Gaca PJ, Matos PAW, Nemcansky J, Heindl LM. Clinical Signs for Differential Diagnosis of Eyelid Tumours. Klin Monbl Augenheilkd 2023; 240:13-23. [PMID: 36706766 DOI: 10.1055/a-1996-0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article aims to present the differential diagnostics of benign and malignant eyelid tumours. The most common malignant eyelid tumour is basal cell carcinoma, followed by squamous cell carcinoma. The common signs of malignity are loss of lashes, ulceration, and infiltration of the lesion. Often the clinical appearance is various and therefore only a histological analysis gives the proper diagnosis. For most tumours, surgical resection is the gold standard of therapy. The reconstruction of the defects should be performed by an experienced oculoplastic surgeon. In malignant tumours that require large safety margins, the defect can be easily very large, and the reconstruction must then be performed with advanced ophthalmic plastic reconstruction techniques.
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Affiliation(s)
- Adam Kopecky
- Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Department of Craniofacial Surgery, University of Ostrava Faculty of Medicine, Olomouc, Czech Republic
| | | | - Piotr Jakub Gaca
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | | | - Jan Nemcansky
- Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Craniofacial Surgery, University of Ostrava Faculty of Medicine, Ostrava, Czech Republic
| | - Ludwig M Heindl
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) - Aachen - Bonn - Cologne - Düsseldorf, Cologne, Germany
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8
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Robert J, Marchand A, Mazereeuw-Hautier J, Boccara O, Martin L, Chiaverini C, Beneton N, Vabres P, Balguerie X, Plantin P, Bessis D, Barbarot S, Dadban A, Droitcourt C, Samimi M, Morel B, Caille A, Maruani A, Leducq S. Quality of life of children with capillary malformations of the lower limbs: Evolution and associated factors. Data from the French national paediatric cohort, CONAPE. Ann Dermatol Venereol 2022; 149:271-275. [PMID: 35810006 DOI: 10.1016/j.annder.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/16/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023]
Affiliation(s)
- J Robert
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France; CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France
| | - A Marchand
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France; CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France; CHRU Tours, Clinical Investigation Center-Inserm 1415, 37000 Tours, France
| | - J Mazereeuw-Hautier
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), Hospital Larrey, University Hospital Center of Toulouse, 31059 Toulouse Cedex 9, France
| | - O Boccara
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), France Université Paris, Paris-centre, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, 75015 Paris, France
| | - L Martin
- Department of Dermatology, University Hospital Center of Angers, 49000 Angers, France
| | - C Chiaverini
- Department of Dermatology, University Hospital Center of Nice, 06000 Nice, France
| | - N Beneton
- Department of Dermatology, Hospital Center of le Mans, 72000 Le Mans, France
| | - P Vabres
- Department of Dermatology, University Hospital Center of Dijon, Reference center for genodermatoses and rare skin diseases (MAGEC), 21000 Dijon, France
| | - X Balguerie
- Department of Dermatology, University Hospital Center of Rouen, 76000 Rouen, France
| | - P Plantin
- Department of Dermatology, Hospital Center of Quimper, 29000 Quimper, France
| | - D Bessis
- Department of Dermatology, University Hospital Center of Montpellier, 34000 Montpellier, France
| | - S Barbarot
- Department of Dermatology, University Hospital Center of Nantes, 44000 Nantes, France
| | - A Dadban
- Department of Dermatology, University Hospital Center of Amiens, 80000 Amiens, France
| | - C Droitcourt
- Department of Dermatology, University Hospital Center of Rennes, 35000 Rennes, France
| | - M Samimi
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France
| | - B Morel
- CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France; CHRU Tours, Department of Pediatric Radiology, 37000 Tours, France
| | - A Caille
- CHRU Tours, Clinical Investigation Center-Inserm 1415, 37000 Tours, France; Universities of Tours and Nantes, SPHERE-INSERM 1246, 37000 Tours, France
| | - A Maruani
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France; CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France; CHRU Tours, Clinical Investigation Center-Inserm 1415, 37000 Tours, France; Universities of Tours and Nantes, SPHERE-INSERM 1246, 37000 Tours, France
| | - S Leducq
- University Hospital Center of Tours (CHRU), Department of Dermatology, Unit of Pediatric Dermatology, 37044 Tours Cedex 9, France; CHRU Tours, Reference center for genodermatoses and rare skin diseases - vascular anomalies (MAGEC), 37000 Tours, France; Universities of Tours and Nantes, SPHERE-INSERM 1246, 37000 Tours, France.
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9
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Appearance-related concerns and their impact on health-related quality of life in patients with peripheral vascular malformations. J Plast Reconstr Aesthet Surg 2022; 75:4202-4211. [DOI: 10.1016/j.bjps.2022.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/21/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
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10
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Wang Q, Yong C, Wang M, Cui L, Yuan SM. Individualized Surgical Management of Refractory Port-Wine Stains in the Scalp and Face: A Single-Center Retrospective Study and a Discussion of Surgical Strategies. Clin Cosmet Investig Dermatol 2022; 15:1527-1535. [PMID: 35945977 PMCID: PMC9357384 DOI: 10.2147/ccid.s370491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Qian Wang
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People’s Republic of China
| | - Chen Yong
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People’s Republic of China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People’s Republic of China
| | - Lei Cui
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People’s Republic of China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People’s Republic of China
- Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, 210002, People’s Republic of China
- Correspondence: Si-Ming Yuan, Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People’s Republic of China, Email
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11
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Xu MN, Wang Q, Wang M, Xu Y, Yuan SM. Enhanced Activation of mTOR Signaling Pathway Was Found in the Hypertrophic and Nodular Lesions of Port Wine Stains. Clin Cosmet Investig Dermatol 2022; 15:643-651. [PMID: 35444442 PMCID: PMC9014311 DOI: 10.2147/ccid.s358612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/27/2022] [Indexed: 11/24/2022]
Abstract
Background Port wine stain (PWS) is a congenital skin lesion involving capillary malformations. Most PWS lesions will gradually become hypertrophic and appear nodular in contour. Current research shows that rapamycin, an mTOR inhibitor, is probably a promising adjunctive therapy for PWS, which suggests that the mTOR signaling pathway may play an important role in its pathological process. Methods From January 2013 to January 2019, 13 samples were obtained during the surgical excision. Each sample was divided into 3 parts according to the type of lesion, namely, the flat, hypertrophic and nodular lesions. Pathologic structures of each type were observed under the microscope after HE staining. The expression of mTORC1, p70S6, p-p70S6, eIF4EBP1 and p-eIF4EBP1 was examined by immunohistochemical staining and western blotting. The location of the expression of mTORC1, p-p70S6 and p-elF4EBP1 was further detected by immunofluorescence staining. Results Large amounts of dilated and malformed vessels were observed in all types of PWS lesions. Abundant hyperplastic hair follicles/glands were shown in the hypertrophic or nodular lesions. Phosphorylation level of p70S6 and elF4EBP1 in PWS was significantly higher than those in normal skin and increased accordingly in the progression of PWS. Activated molecules in mTOR signaling pathway were mostly located in the endothelium of malformed vessels. They were also located in the hyperplastic hair follicles/glands of hypertrophic and nodular lesions. Conclusion The mTOR signaling pathway was increasingly activated during the progression of PWS. Enhanced activation of mTOR signaling pathway may contribute to the hypertrophy and nodularity of PWS. The results provide preliminary evidence for treating PWS and related syndromes by inhibiting mTOR signaling pathway.
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Affiliation(s)
- Meng-Nan Xu
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People's Republic of China
| | - Qian Wang
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People's Republic of China
| | - Min Wang
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People's Republic of China
| | - Yuan Xu
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People's Republic of China
| | - Si-Ming Yuan
- Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People's Republic of China.,Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu, 210002, People's Republic of China
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12
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Kang M, Parsi K. Treatment of facial hypertrophic capillary malformations with tumescent-assisted sclerotherapy. Australas J Dermatol 2022; 63:235-239. [PMID: 35411941 PMCID: PMC9321826 DOI: 10.1111/ajd.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/10/2022] [Accepted: 03/20/2022] [Indexed: 11/30/2022]
Abstract
Facial capillary malformations (CMs) become hypertrophic and nodular overtime and pose great therapeutic challenge. Here, we describe safe and effective use of tumescent-assisted sclerotherapy (TAS) in conjunction with yellow vascular laser (577 nm) for the treatment of HFCMs. Three patients underwent TAS were included in the case series, and complete resolution in nodularity was achieved in all patients with TAS, with no major complications such as skin necrosis, distal embolisation, blindness and neurological adverse events such as stroke or TIA occurred in any patients.
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Affiliation(s)
- Mina Kang
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, New South Wales, Australia.,University of New South Wales, Sydney, Australia
| | - Kurosh Parsi
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, New South Wales, Australia.,University of New South Wales, Sydney, Australia.,Australasian Vascular Anomalies Centre, New South Wales, Australia
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13
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Pellacani A, Rozell-Shannon L, Negrello S, Di Bartolomeo M, Anesi A, Feminò R, Mariotti I, Chiarini L, Colletti G. The vanishing port-wine stain birthmark—consideration for a rare type of congenital vascular anomaly. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01948-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Han Y, Yu W, Wang L, Cen Q, Luo L, Zhu J, Zhang X, Ma G, Lin X. Histological Characteristics of Port-Wine Stains with Complete Regression After Photodynamic Therapy Treatment: A 7-Year Follow-Up. Photobiomodul Photomed Laser Surg 2022; 40:159-162. [PMID: 35298284 DOI: 10.1089/photob.2021.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Vascular-targeted photodynamic therapy (PDT) is an effective alternative treatment choice for port-wine stains (PWSs). The histological characteristics of PWSs after PDT treatment have not yet been reported. Objective: To investigate the morphological features of PWSs treated by PDT and define the histopathological characteristics of PWS that achieve clinical cure. Methods: Thirteen patients with facial PWSs, who presented with complete regressive PWS lesions after a mean of 4.38 (standard deviation = 4.907) sessions of PDT. Post-treatment biopsy samples were obtained from each patient. The number of blood vessels, vascular diameter, and depth were measured and compared in all samples of PDT-regressive sites, PDT-resistant sites, and normal skin. Results: Within the 7-year follow-up after PDT, there was no recurrence in the regression area of PDT. In the PDT-regressive sites, within 800 μm of the dermal-epidermal junction, the dilated vessels were occluded and remained fissure-like after PDT. Conclusions: When the vascular lesions within 800 μm of the dermal-epidermal junction were closed after PDT, a stable clinical cure (no recurrence) was achieved.
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Affiliation(s)
- Yue Han
- Department of Plastic and Reconstructive Surgery and Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China.,Department of Burn and Plastic Surgery, Affiliated to Shandong First Medical University, Shandong Provincial Hospital, Jinan, China
| | - Wenxin Yu
- Department of Plastic and Reconstructive Surgery and Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Lizhen Wang
- Shanghai Key Laboratory of Stomatology, Department of Oral Pathology, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Qingqing Cen
- Department of Plastic and Reconstructive Surgery and Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Lan Luo
- Department of Plastic and Reconstructive Surgery and Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Jiafang Zhu
- Department of Laser and Aesthetic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Xiaolin Zhang
- Department of Plastic and Reconstructive Surgery and Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Gang Ma
- Department of Plastic and Reconstructive Surgery and Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery and Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
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15
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The Use of Neodymium-Doped Yttrium Aluminum Garnet Laser for Treatment of Hypertrophic Port-Wine Stain. Case Rep Dermatol Med 2022; 2022:8788417. [PMID: 35127181 PMCID: PMC8808235 DOI: 10.1155/2022/8788417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/08/2022] [Indexed: 11/21/2022] Open
Abstract
Port-wine stains (also called nevus flammeus) are congenital malformations of the capillaries and postcapillary venules. They occur in 0.1–2% of newborns without sex predilection. Although PWS lesions are flat early in life, with age, they become hypertrophic and darker. Pulsed dye laser therapy is the standard of care for treating these lesions, although other laser wavelengths have been utilized with varying degrees of success. We present the case of a gentleman with a hypertrophic PWS who had an excellent response to Nd:YAG laser treatment. The increased tissue penetration of longer laser wavelengths may be of benefit to patients with hypertrophic PWS, and further research into this concept is warranted.
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16
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Therapeutic Strategies for Untreated Capillary Malformations of the Head and Neck Region: A Systematic Review and Meta-Analyses. Am J Clin Dermatol 2021; 22:603-614. [PMID: 34160795 PMCID: PMC8421304 DOI: 10.1007/s40257-021-00616-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 01/19/2023]
Abstract
Background Capillary malformations of the head and neck region often cause psychological and physical burden. As the effectiveness of modern laser and light therapies is still suboptimal, patients often seek different therapeutic strategies. Other recognized, but not routinely proposed therapies include cosmetic camouflage, surgery, and medical tattooing. Information on therapeutic outcomes is currently lacking for patients to adequately participate in the treatment decision-making process. Objective The objective of this systematic review was to review the effectiveness and safety of recognized therapies for untreated capillary malformations of the head and neck: laser and light treatment modalities, photodynamic therapy, cosmetic camouflage, medical tattooing, and surgery. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched up to 16 December, 2020 for observational and experimental studies examining recognized therapies for untreated capillary malformations of the head and neck. Two reviewers independently evaluated the risk of bias of included studies. Predefined treatment and safety outcomes of pooled data were scored using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results We included 48 observational and three randomized studies (totaling 3068 patients), evaluating nine different therapies. No studies on surgery or cosmetic camouflage matched our inclusion criteria. The pooled proportion of patients reaching a ≥75% clearance was 43% (95% confidence interval 24–64%; I2 = 55%) for the pulsed dye laser after three to eight treatment sessions (GRADE score: very low). Other therapies were less effective. Hyperpigmentation was most frequently described after the pulsed dye laser (incidences up to 40%). Pain was most common after photodynamic therapy, yet the intensity was unreported. Substantial heterogeneity among studies as to patient characteristics and outcomes limited pooling and data comparisons. Conclusions The pulsed dye laser seems preferable for treatment-naive capillary malformations of the head and neck region, yet demonstrates greater hyperpigmentation rates compared with other therapies. Our results are, however, based on low-quality evidence. Future studies using uniform outcome measures and validated metrics are warranted for study comparability. Based on this systematic review, clinicians and patients should be aware of the limited evidence about the available options when making (shared) treatment decisions for capillary malformations. Trial Registration Review registration number PROSPERO database: CRD42020199445. Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00616-5.
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17
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Cutrone M. Quadri dermatologici della regione perioculare. MEDICO E BAMBINO 2021; 40:247-254. [DOI: 10.53126/meb40247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Un piccolo atlante in 36 immagini
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Affiliation(s)
- Mario Cutrone
- Ospedale dell'Angelo, Aulss 3 (Mestre - Venezia) e Ospedale San Bortolo Aulss 8 (Vicenza)
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18
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Abstract
Sturge Weber Syndrome is characterized by the classic triad of a facial port-wine stain, leptomeningeal angiomatosis, and glaucoma. The resultant facial vascular anomaly can lead to soft tissue and bone irregularities, causing psychosocial distress and mental health morbidity. When severe, patients can opt for multi-staged surgical intervention by reconstructive surgeons to restore normal symmetry and improve the aesthetic appearance of the face. This study reports a case of surgical correction for severe facial vascular malformation resulting in poor outcomes due to the associated mental comorbidities seen in Sturge Weber Syndrome. A 37-year-old male with previously diagnosed Sturge Weber Syndrome presented to the outpatient craniofacial clinic for surgical evaluation of a large facial tuberous hemangioma. The patient underwent multiple operations for facial reconstruction including a staged full-thickness skin graft, facial recontouring, and extracranial correction of vertical orbital dystopia. The case was complicated by the patient's poorly controlled seizure disorder and psychosocial illness, resulting in self-mutilation of the repair and poor follow-up. Over the span of 10 years, the patient's mental illness caused him to fail numerous attempts at facial restoration and ultimately led to a poor final result. The psychosocial distress seen in patients with Sturge Weber Syndrome can adversely affect surgical outcomes. Physicians should be mindful of the possible complications that can arise in these patients and have the clinical means to address them.
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Affiliation(s)
- Bar Y Ainuz
- Plastic and Reconstructive Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Erin M Wolfe
- Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - S Anthony Wolfe
- Plastic and Reconstructive Surgery, Nicklaus Children's Hospital, Miami, USA
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19
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Sabeti S, Tackett KJ, Ball KL, Terrell J, Kelly KM, Burkhart C. Lasers, Birthmarks, and Sturge-Weber Syndrome: A Pilot Survey. Lasers Surg Med 2020; 53:104-108. [PMID: 32960979 DOI: 10.1002/lsm.23321] [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: 05/26/2020] [Revised: 08/23/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES There is limited or no data on the experience of patients with Sturge-Weber Syndrome (SWS) and/or their parents who seek out laser treatments for their port-wine birthmark (PWB). Our study aimed to develop a survey to understand patient perspectives on laser therapy and subsequent behaviors while focusing on three elements of the health belief model: perceived susceptibility, perceived benefits, and perceived barriers. STUDY DESIGN/MATERIALS AND METHODS A 31 item survey was developed and sent to 650 members of the Sturge-Weber Foundation. The survey included questions regarding four domains: demographics, disease severity, laser experience, and perceptions and behaviors. Logistic regression models and bivariate analyses were conducted to analyze the results. RESULTS Among the 123 respondents, earlier initiation of laser treatments was associated with greater birthmark satisfaction. Overall satisfaction increased up to 20 treatments and then leveled off. Color satisfaction increased up to 100 laser treatments; however, the flatness of the PWB was not associated with the number of laser treatments. The perceived benefits of lasers were not associated with the number of lifetime treatments or with spending. However, the perceived susceptibility was associated with greater spending on travel and medical expenses. CONCLUSION The results of our survey provide insight into SWS patient experiences, beliefs, and behaviors regarding laser therapy. Further exploration of these variables may allow for the improvement of the care experience. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Sara Sabeti
- Department of Dermatology, Irvine School of Medicine, University of California, Irvine, California
| | - Kelly J Tackett
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina
| | | | | | - Kristen M Kelly
- Department of Dermatology, Irvine School of Medicine, University of California, Irvine, California
| | - Craig Burkhart
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina
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20
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The molecular pathophysiology of vascular anomalies: Genomic research. Arch Plast Surg 2020; 47:203-208. [PMID: 32453927 PMCID: PMC7264916 DOI: 10.5999/aps.2020.00591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/30/2020] [Indexed: 12/28/2022] Open
Abstract
Vascular anomalies are congenital localized abnormalities that result from improper development and maintenance of the vasculature. The lesions of vascular anomalies vary in location, type, and clinical severity of the phenotype, and the current treatment options are often unsatisfactory. Most vascular anomalies are sporadic, but patterns of inheritance have been noted in some cases, making genetic analysis relevant. Developments in the field of genomics, including next-generation sequencing, have provided novel insights into the genetic and molecular pathophysiological mechanisms underlying vascular anomalies. These insights may pave the way for new approaches to molecular diagnosis and potential disease-specific therapies. This article provides an introduction to genetic testing for vascular anomalies and presents a brief summary of the etiology and genetics of vascular anomalies.
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21
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Zhou J, Qi Z, Jin X. Surgical correction for patients with port-wine stains and facial asymmetry. J Cosmet Dermatol 2020; 19:3307-3314. [PMID: 32307862 DOI: 10.1111/jocd.13415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/13/2020] [Accepted: 03/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The refractory port-wine stains are often associated with soft and hard tissue hypertrophy leading to facial asymmetry and psychological problems. AIMS The authors describe and illustrate a surgical strategy for the treatment of both hard and soft tissue malformations in patients with port-wine stains to restore facial symmetry. METHODS The medical records, photographs of two patients with soft and hard tissue hypertrophy were reviewed. After physical examinations, 3-dimensional computed tomography was conducted to evaluate bony asymmetry. The surgical strategy was designed according to individual malformation and requests. RESULTS Both patients had congenital port-wine stains that were resistant to laser therapy. As they grew up, they developed both soft and hard tissue hypertrophy. Zygoma, maxilla, nose, and lips are involved, causing facial asymmetry, deviated nose, increased dental show and malocclusion. To correct bony malformation, orthognathic surgery, and facial bone contouring including zygomatic reduction, mandibular angles osteotomy and genioplasty were performed. After the correction of the bony factor, soft tissue symmetry was improved via resection, autologous fat grafting, liposuction, and rhinoplasty. Both patients were satisfied with the surgical result. CONCLUSIONS To acquire facial symmetry, surgical correction is inevitable for patients with port-wine stains associated with soft and hard tissue hypertrophy. The authors describe the successive correction of bony and soft tissue asymmetry to achieve harmonious surgical outcomes.
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Affiliation(s)
- Jing Zhou
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zuoliang Qi
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaolei Jin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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22
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Kawaguchi A, Kunimoto K, Inaba Y, Mikita N, Kaminaka C, Kanazawa N, Yamamoto Y, Kakimoto N, Suenaga T, Takeuchi T, Suzuki H, Baba N, Jinnin M. Distribution analysis of infantile hemangioma or capillary malformation on the head and face in Japanese patients. J Dermatol 2019; 46:849-852. [PMID: 31418467 DOI: 10.1111/1346-8138.15051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022]
Abstract
Infantile hemangioma is one of the most common tumors in infancy. Delivery may be a clue for the trigger of infantile hemangioma formation in the head and face areas. In this study, we tried to plot localization of infantile hemangioma as well as capillary malformation on the head and face, and compared them to identify their characteristics and risk factors. The distribution of 104 lesions in 100 patients with infantile hemangioma was as follows: 32 lesions on the head, 12 on the forehead, 57 on the cheek and three in the jaw area. We could not find a statistically significant correlation of the distribution with three clinical subtypes (superficial, deep and mixed), sex or size of the lesions. However, the lesions in the jaw or chin areas were significantly less frequent than other areas (P = 0.0008 or 0.03, respectively). This tendency was not found in 40 patients with capillary malformation. Mechanical stress to jaw or chin areas may be less than other areas in normal cephalic delivery. Considering the emergence after birth and age-dependent involution of infantile hemangioma, we speculate that physiological events including perinatal hypoxia or mechanical stress during delivery as the trigger of hemangioma formation. Taken together, our results may reveal the contribution of mechanical stress to the trigger of infantile hemangioma, not capillary malformation, and may facilitate clinical differentiation between the two diseases by their localization. Further studies with an increased number of patients will be necessary to validate the finding.
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Affiliation(s)
- Ami Kawaguchi
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Kayo Kunimoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Yutaka Inaba
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Naoya Mikita
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Chikako Kaminaka
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Nobuo Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Suenaga
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Takashi Takeuchi
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Naoko Baba
- Department of Dermatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
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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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Bongard RD, Lepley M, Gastonguay A, Syrlybaeva RR, Talipov MR, Lipinsky RAJ, Leigh NR, Brahmbhatt J, Kutty R, Rathore R, Ramchandran R, Sem DS. Discovery and Characterization of Halogenated Xanthene Inhibitors of DUSP5 as Potential Photodynamic Therapeutics. J Photochem Photobiol A Chem 2019; 375:114-131. [PMID: 31839699 PMCID: PMC6910256 DOI: 10.1016/j.jphotochem.2019.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dual specific phosphatases (DUSPs) are an important class of mitogen-activated protein kinase (MAPK) regulators, and are drug targets for treating vascular diseases. Previously we had shown that DUSP5 plays a role in embryonic vertebrate vascular patterning. Herein, we screened a library of FDA-approved drugs and related compounds, using a para-nitrophenylphosphate substrate (pNPP)-based assay. This assay identified merbromin (also known as mercurochrome) as targeting DUSP5; and, we subsequently identified xanthene-ring based merbromin analogs eosin Y, erythrosin B, and rose bengal, all of which inhibit DUSP5 in vitro. Inhibition was time-dependent for merbromin, eosin Y, 2',7'-dibromofluorescein, and 2',7'-dichlorofluorescein, with enzyme inhibition increasing over time. Reaction progress curve data fit best to a slow-binding model of irreversible enzyme inactivation. Potency of the time-dependent compounds, except for 2',7'-dichlorofluorescein, was diminished when dithiothreitol (DTT) was present, suggesting thiol reactivity. Two additional merbromin analogs, erythrosin B and rose bengal also inhibit DUSP5, but have the therapeutic advantage of being less sensitive to DTT and exhibiting little time dependence for inhibition. Inhibition potency is correlated with the xanthene dye's LUMO energy, which affects ability to form light-activated radical anions, a likely active inhibitor form. Consistent with this hypothesis, rose bengal inhibition is light-dependent and demonstrates the expected red shifted spectrum upon binding to DUSP5, with a Kd of 690 nM. These studies provide a mechanistic foundation for further development of xanthene dyes for treating vascular diseases that respond to DUSP5 inhibition, with the following relative potencies: rose bengal > merbromin > erythrosin B > eosin Y.
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Affiliation(s)
- Robert D. Bongard
- Center for Structure-based Drug Design and Development, Department of Pharmaceutical Sciences, Concordia University Wisconsin, 12800 North Lake Shore Drive, Mequon, WI 53097
| | - Michael Lepley
- Immucor Inc., 20925 Crossroads Circle, Waukesha, WI 53186
| | - Adam Gastonguay
- Nelson Mullins, One Post Office Square, 30 Floor, Boston MA 02109
| | - Raulia R. Syrlybaeva
- Department of Chemistry and Biochemistry, New Mexico State University, MSC 3C, P.O. Box 30001, Las Cruces, NM 88003
| | - Marat R. Talipov
- Department of Chemistry and Biochemistry, New Mexico State University, MSC 3C, P.O. Box 30001, Las Cruces, NM 88003
| | - Rachel A. Jones Lipinsky
- Department of Biochemistry, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
- Department of Chemistry, Marquette University, Wehr Chemistry Building, P.O. Box 1881, 535 N. 14 Street, Milwaukee, WI 53201
| | - Noah R. Leigh
- Milwaukee Health Department, 841 N. Broadway, Milwaukee, WI 53202
| | - Jaladhi Brahmbhatt
- Eli Lilly and Company, Lilly Corporate Center Paten, Indianapolis, IN 46285
| | - Raman Kutty
- Department of Pediatrics, Obstetrics and Gynecology, Children’s Research Institute (CRI) Developmental Vascular Biology Program, Translational and Biomedical Research Center, 8701 Watertown Plank Road, P.O. Box 26509, Milwaukee, WI 53226
| | - Rajendra Rathore
- Department of Chemistry, Marquette University, Wehr Chemistry Building, P.O. Box 1881, 535 N. 14 Street, Milwaukee, WI 53201
| | - Ramani Ramchandran
- Department of Pediatrics, Obstetrics and Gynecology, Children’s Research Institute (CRI) Developmental Vascular Biology Program, Translational and Biomedical Research Center, 8701 Watertown Plank Road, P.O. Box 26509, Milwaukee, WI 53226
| | - Daniel S. Sem
- Center for Structure-based Drug Design and Development, Department of Pharmaceutical Sciences, Concordia University Wisconsin, 12800 North Lake Shore Drive, Mequon, WI 53097
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25
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Karppinen T, Kantola E, Karppinen A, Rantamäki A, Kautiainen H, Mordon S, Guina M. Treatment of telangiectasia on the cheeks with a compact yellow (585 nm) semiconductor laser and a green (532 nm) KTP laser: a randomized double-blinded split-face trial. Lasers Surg Med 2019; 51:223-229. [PMID: 30614016 DOI: 10.1002/lsm.23051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The primary objective of this study was to compare a traditional green KTP laser to a new investigational yellow laser (PhotoLase) in the treatment of facial telangiectasia in terms of the treatment outcomes. The secondary objective was to assess the functionality and reliability of the PhotoLase system from the perspective of the user. STUDY DESIGN/METHODS The study was a randomized split-face double-blinded study that compared the treatment efficacy of the 532-nm KTP laser and the investigational 585-nm PhotoLase laser. One or two treatments were given based on the response of the first treatment. The improvement of telangiectasia was graded according to a 7-point Telangiectasia Grading Scale (TGS) by the subjects and blinded physicians. The subjects assessed the amount of pain during the treatments using Visual Analogue Scale (VAS), and evaluated adverse effects 2-3 days after the treatment(s) using a self-assessment form. RESULTS At least 50% improvement was seen in 15/18 subjects after the first PhotoLase treatment, and a similar result was observed for KTP, as assessed by the blinded physicians (P = 0.29). In the subjects' assessment, 7/18 subjects had at least 50% improvement after the first PhotoLase treatment, whereas at least 50% improvement was observed for 10/18 subjects in the KTP side, the difference being significant (P = 0.008). The amount of pain was higher with PhotoLase compared to KTP (67.7 vs. 34.6, P < 0.001). There was no difference in the frequency of erythema, crusting or purpura between the devices, but more blistering and less edema were seen after PhotoLase treatment (P < 0.05). Treatment with PhotoLase was evaluated to be 4.7-fold faster than with KTP and the PhotoLase system was more compact, narrower, lighter, and easier to carry than KTP. CONCLUSIONS The investigational PhotoLase laser enables significantly faster treatments, but the process is somewhat more painful than with KTP, otherwise providing a similar clinical outcome in the treatment of facial telangiectasia. Treatment Protocol Lasers Surg. Med. 51:223-229, 2019. © Wiley Periodicals, Inc.
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Affiliation(s)
- Toni Karppinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland.,Epilaser Oy, Lempäälä, Finland
| | - Emmi Kantola
- Optoelectronics Research Centre, Tampere University of Technology (TUT), Korkeakoulunkatu 3, 33720, Tampere, Finland
| | | | - Antti Rantamäki
- Optoelectronics Research Centre, Tampere University of Technology (TUT), Korkeakoulunkatu 3, 33720, Tampere, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland.,Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Serge Mordon
- The French National Institute of Health and Medical Research (INSERM), INSERM U1189-ONCO-THAI, avenue Oscar Lambert 1, 59037, Lille Cedex, France
| | - Mircea Guina
- Optoelectronics Research Centre, Tampere University of Technology (TUT), Korkeakoulunkatu 3, 33720, Tampere, Finland
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Lee JW, Chung HY. Vascular anomalies of the head and neck: current overview. Arch Craniofac Surg 2018; 19:243-247. [PMID: 30613084 PMCID: PMC6325330 DOI: 10.7181/acfs.2018.02383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022] Open
Abstract
Vascular anomalies are disorders of the endothelium and surrounding cells that can affect the vasculature and involve any anatomical structure. The most common problem associated with vascular anomalies is psychological distress related to disfigurement as well as functional defects, as many lesions affect the head and neck. This article provides an overview of the current clinical features that distinguish the major types of vascular anomalies that affect the head and neck.
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Affiliation(s)
- Jeong Woo Lee
- Department of Plastic and Reconstructive Surgery, Vascular Anomalies Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, Vascular Anomalies Center, School of Medicine, Kyungpook National University, Daegu, Korea
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Takkar B, Saxena H, Sharma B, Rathi A. Generalised nevus flammeus, episcleral capillary malformation and glaucoma. BMJ Case Rep 2018; 2018:bcr-2018-227248. [PMID: 30344159 DOI: 10.1136/bcr-2018-227248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Harsha Saxena
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Anubha Rathi
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Blei F. Update February 2018. Lymphat Res Biol 2018. [DOI: 10.1089/lrb.2018.29035.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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