Abstract
Tissue effects of vascular lesion laser treatment are incompletely understood. Injury caused by pulsed dye laser (PDL) treatment may result in altered expression of mediators associated with angiogenesis. Eight human subjects had one angioma treated with PDL (7 mm, 1.5 millisecond pulse duration, 9 J/cm(2), cryogen spray cooling of 30 millisecond with a 30 millisecond delay). One week later, three biopsies were taken: normal skin, untreated angioma, angioma post-PDL. Tissue was frozen and sections processed for immunohistochemistry staining of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), matrix metalloproteinase 9 (MMP-9), and angiopoietin 2 (ANG-2). Images were graded in a blinded fashion by a board certified dermatopathologist. There were no clear trends in VEGF expression in the epidermis, dermis, or endothelial cells. As compared to normal skin, angiomas demonstrated the following: bFGF was decreased in the epidermis; MMP-9 was decreased or unchanged in the epidermis and increased in the endothelial cells; ANG-2 was increased in the endothelial cells. When comparing normal skin to angiomas + PDL, bFGF was decreased in the epidermis and increased in the dermis; MMP-9 was decreased or unchanged in the epidermis; ANG-2 was again increased in the endothelial cells. Comparison of staining in angioma to angioma + PDL samples revealed increased dermal bFGF expression. Alterations in angiogenesis mediators were noted after PDL. Angiogenesis mediator changes associated with PDL treatment differed from those previously reported for incisional biopsies. This pilot study can guide future work on laser-induced alterations in vascular lesions and such information may ultimately be used to optimize treatment outcomes.
Highlights
The flash-lamp pumped pulsed dye laser (PDL) has been used for decades to safely and effectively treat a wide range of cutaneous vascular lesions including angiomas, telangiectasia, and vascular birthmarks [1]
There were no clear trends in vascular endothelial growth factor (VEGF) expression in the epidermis, dermis, or endothelial cells
As compared to normal skin, angiomas demonstrated the following: basic fibroblast growth factor (bFGF) was decreased in the epidermis; matrix metalloproteinase 9 (MMP-9) was decreased or unchanged in the epidermis and increased in the endothelial cells; angiopoietin 2 (ANG-2) was increased in the endothelial cells
Summary
The flash-lamp pumped pulsed dye laser (PDL) has been used for decades to safely and effectively treat a wide range of cutaneous vascular lesions including angiomas, telangiectasia, and vascular birthmarks [1]. It is controlled by a balance between angiogenic growth factors and inhibitors. An imbalance of these factors can lead to unwanted vessel formation and cutaneous disease including vascular malformations and tumors [3,4]. Our group and others have hypothesized that laser therapy of vascular lesions stimulates production of angiogenesis growth factors, promoting recurrence of targeted vascular lesions and limiting treatment effects. Tissue effects of vascular lesion laser treatment are incompletely understood. Injury caused by pulsed dye laser (PDL) treatment may result in altered expression of mediators associated with angiogenesis
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