Abstract
The degree of port wine stain (PWS) blanching following pulsed dye laser (PDL) therapy remains variable and unpredictable. Because of the limitations of current PDL therapy, alternative treatment approaches should be explored. The objective was to evaluate a novel methodology for selective vascular damage, combined photodynamic (PDT) and photothermal (PDL) treatment, using the in vivo chick chorioallantoic membrane (CAM) model. Thirty microliters of benzoporphyrin derivative monoacid ring A (BPD) solution was administered intraperitoneally into chick embryos at day 12 of development. Study groups were: (1) control (no BPD, no light); (2) BPD alone; (3) continuous wave irradiation (CW) alone (576 nm, 60 mW/cm2, 125 seconds); (4) CW + PDL; (5) BPD+PDL; (6) PDT (BPD+CW); (7) PDL alone (585 nm, 4 J/cm(2)); and (8) PDT+PDL (BPD + CW followed immediately by PDL). Vessels were videotaped prior to, and at 1 hour post-intervention and then assessed for damage based on the following scale: 0, no damage; 1, coagulation; 1.5, vasoconstriction; 2.0, coagulation+vasoconstriction; 2.5, angiostasis; 3.0, hemorrhage. Damage scores were weighted by vessel "order." PDT + PDL resulted in significantly (P < 0.01) more severe vascular damage than was observed in any other study group: 127% more than PDT, 47% more than PDL alone. PDT + PDL is a novel and promising approach for selective vascular damage and may offer a more effective method for treatment of PWS and other vascular skin lesions.
Highlights
Pulsed dye laser (PDL) treatment of port wine stain (PWS) produces reasonably good results in some patients because of its ability to destroy selectively dermal blood vessels
We investigate the suitability of benzoporphyrin derivative monoacid ring A (BPD), a second-generation, vascular-specific photosensitizer [14,15,16,17,18]
We report enhanced vascular injury achieved by combining Photodynamic therapy (PDT) with pulsed dye laser (PDL) using the in vivo chick chorioallantoic membrane (CAM) model, as previously used for studying vascular effects of BPD-PDT [23,24,25] or PDL [26,27,28] alone
Summary
Pulsed dye laser (PDL) treatment of port wine stain (PWS) produces reasonably good results in some patients because of its ability to destroy selectively dermal blood vessels. By careful selection of photosensitizer and wavelength for laser irradiation, PDT injury can be localized to vessels at a desired depth, allowing effective treatment of vascular lesions without injury to the overlying skin. BPD is expected to be an excellent photosensitizer for PWS treatment based on the following characteristics: (1) vascular compartmentalization [14,15,16,17]; (2) proven safety and efficacy in humans [19,20]; (3) photosensitivity of relatively short duration (1–5 days depending on dose administered) [20]; and (4) presence of an absorption peak in the desired yellow wavelength range. Conclusions: PDT þ PDL is a novel and promising approach for selective vascular damage and may offer a more effective method for treatment of PWS and other vascular skin lesions.
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