Treatment Of Port-wine Stains Research Articles

Photodynamic therapy for the treatment of port-wine stains in phakomatosis pigmentovascularis.

Phakomatosis pigmentovascularis (PPV) is a rare congenital syndrome. Only a few studies have reported the treatment of PPV, including a case using photodynamic therapy (PDT) to treat PPV-associated port-wine stains (PWS). To investigating the efficacy and adverse effects of hemoporfin-PDT in PPV-associated PWS. The efficacy and adverse effects in patients with PPV who underwent two sessions of hemoporfin-PDT from January 2019 to December 2022 were retrospectively analyzed. Twenty patients were included (13 females, 7 males, age range: 2-31 years; mean: 8.20 ± 8.92 years). Two, nine, seven, and two patients had PPV types Ia, IIa, IIb, and IIIa, respectively. After two treatments, the visual evaluation indicated the color of the PWS in 4, 5, 6, and 5 patients showed poor, fair, good, and excellent improvements, respectively. The combined good and excellent improvement rates in patients with PWS and pigmentary nevus overlapping in the same treatment area and in patients with PWS in the treatment areas only were 33.3% versus 87.5%, respectively, and were significantly different (p = 0.02). Minor side effects, such as edema, scabbing, hyperpigmentation, and blistering, were observed in some patients after PDT. Hemoporfin-PDT is an effective treatment for PPV-associated PWS. Patients with PWS and pigmentary nevus overlapping in the same treatment area showed poorer efficacy than patients with PWS in the treatment areas only.

The effect of autophagy on hemoporfin-mediated photodynamic therapy in human umbilical vein endothelial cells

SignificanceHemoporfin-mediated photodynamic therapy (HMME-PDT) has been recognized as a safe and effective treatment for port wine stain (PWS). However, some patients show limited improvement even after multiple treatments. Herein, we aim to explore the effect of autophagy on HMME-PDT in human umbilical vein endothelial cells (HUVECs), so as to provide theoretical basis and treatment strategies to enhance clinical effectiveness. MethodsEstablish the in vitro HMME-PDT system by HUVECs. Apoptosis and necrosis were identified by Annexin Ⅴ-FITC/PI flow cytometry, and autophagy flux was detected by monitoring RFP-GFP-LC3 under the fluorescence microscope. Hydroxychloroquine and rapamycin were employed in the mechanism study. Specifically, the certain genes and proteins were qualified by qPCR and Western Blot, respectively. The cytotoxicity was measured by CCK-8, VEGF-A secretion was determined by ELISA, and the tube formation of HUVECs was observed by angiogenesis assay. ResultsIn vitro experiments revealed that autophagy and apoptosis coexisted in HUVECs treated by HMME-PDT. Apoptosis was dominant in early stage, while autophagy gradually increased in the middle and late stage. AMPK, AKT and mTOR participated in the regulation of autophagy induced by HMME-PDT, in which AMPK was positive regulation, while AKT and mTOR were negative regulation. Hydroxychloroquine could not inhibit HMME-PDT-induced autophagy, but capable of blocking the fusion of autophagosomes with lysosome. Rapamycin might cooperate with HMME-PDT to enhance autophagy in HUVECs, leading to increased cytotoxicity, reduced VEGF-A secretion, and weakened angiogenesis ability. ConclusionsBoth autophagy and apoptosis contribute to HMME-PDT-induced HUVECs death. Pretreatment of HUVECs with rapamycin to induce autophagy might enhance the photodynamic killing effect of HMME-PDT on HUVECs. The combination of Rapamycin and HMME-PDT is expected to further improve the clinical efficacy.

Clinical observation on the therapeutic effect of Hematoporphyrin Monomethyl Ether

SignificanceHematoporphyrin Monomethyl Ether (HMME) is a promising photosensitizer for photodynamic therapy (PDT) and has been widely applied in the treatment of port-wine stains (PWS). ApproachPatients with PWS were treated with HMME-PDT, and efficacy was evaluated by comparing photographs and CDFI examination. Results9 of the 33 cases were cured (27.27%), 10 indicated a good efficacy (30.30%), 11 showed alleviation (33.33%), while 3 had no obvious efficacy (9.09%). The efficacy was related to the types of lesions and the total number of therapeutic sessions. More sessions the purple type and nodular thickening type received, better clinical cosmetic results were. CDFI may be an excellent technique to evaluate efficacy. ConclusionsHMME-PDT serves as a safe and effective approach for improving PWS. The clinical therapeutic effect is affected by the type of lesions and the total number of therapeutic sessions. CDFI examination may be an excellent evaluation method.

Preliminary study on vascular-targeted polyphenol nanoparticles in photodynamic therapy of port-wine stains

SignificanceA combination of polyphenol with near infrared photodynamic therapy (PDT) and vascular-targeting nanoparticles holds significant promise as a potential treatment for port-wine stains (PWS). The anti-angiogenic properties of the polyphenol, along with the targeted approach of the nanoparticles and the ability of PDT to selectively damage tissue, make this treatment approach particularly compelling. ApproachUsing EOMA cells for invitro experiment to examine the anti-angiogenesis effects of PDT using ELC, which is self-assembly Epigallocatechin-3-gallate (EGCG) nanoparticles loading with Ce6 photosensitizer. ResultsIn comparison to free Ce6, ELC resulted in increased intracellular uptake of Ce6, leading to improved cytotoxicity when used with laser while maintaining good biocompatibility. Furthermore, ELC enhanced the generation of reactive oxygen species (ROS) within cells. However, ELC did not demonstrate any advantages in inducing apoptosis. ConclusionsPDT using ELC is a promising method for PWS.

Rapamycin and HPPH Co-Loaded Nanodrug Delivered via Dissolvable Microneedles to Treat Port-Wine Stains

Port-wine stains are a kind of dermatological disease of congenital capillary malformation. Based on the biological characteristics of port-wine stains and the advantages of microneedle transdermal administration, we intend to construct a nanodrug co-loaded with rapamycin (RPM), an anti-angiogenesis drug, and photochlor (HPPH), a photosensitizer, and integrate the nanodrug with dissolvable microneedles (MN) to achieve anti-angiogenesis and photodynamic combination therapy for port-wine stains. First, RPM and HPPH co-loaded nanoparticles (RPM-HPPH NP) were prepared by the emulsification solvent-volatilization method, and its ability to generate reactive oxygen species (ROS) was investigated under 660 nm laser irradiation. Mouse hemangioendothelioma endothelial cells (EOMA) were used as the subjects of the study. The cellular uptake behaviors were examined by fluorescence microscopy and flow cytometry. The cytotoxicity effects of RPM-HPPH NP with or without 660 nm laser irradiation on EOMA cells were examined by MTT assays (with free RPM serving as the control). Then, hyaluronic acid (HA) dissolvable microneedles loaded with RPM-HPPH NP (RPM-HPPH NP@HA MN) were obtained by compounding the nanodrug with HA dissolvable microneedle system through the molding method. The morphological characteristics and mechanical properties of RPM-HPPH NP@HA MN were investigated by scanning electron microscope and electronic universal testing machine. The penetration ability of RPM-HPPH NP@HA MN on the skin of nude mice was evaluated by trypan blue staining and H&E staining experiment. The RPM-HPPH NP prepared in the study had a particle size of 150 nm and generated large amounts of ROS under laser irradiation. At the cellular level, RPM-HPPH NP was taken up by EOMA cells in a time-dependent manner. The cytotoxicity of RPM-HPPH NP was higher than that of free RPM with or without laser irradiation. Under laser irradiation, RPM-HPPH NP exhibited stronger cytotoxic effects and the difference was statistically significant (P<0.05). The height of the needle tip of RPM-HPPH NP@HA MN was 600 µm and the mechanical property of a single needle was 0.75048 N. Trypan blue staining and HE staining showed that pressing on the microneedles could produce pores on the skin surface and penetration of the stratum corneum. RPM-HPPH NP@HA MN can deliver RPM-HPPH NP percutaneously to the lesion tissue and realize the synergistic treatment of port-wine stains with anti-angiogenic therapy and photodynamic therapy, providing a new strategy for the construction of nanodrug-loaded microneedle delivery system and the clinical treatment of port-wine stains.

Complication rates and safety of pulsed dye laser treatment for port-wine stain: a systematic review and meta-analysis.

Pulsed dye laser (PDL) is the most commonly used method for port-wine stain (PWS); however, no studies have reported the safety of PDL. This review aimed to collect and summarize complications reported in relevant literature, assess complication rates in treating PWS with PDL, and explore the relevant influencing factors. A systematic review and meta-analysis were conducted to search for related studies in PubMed, Embase, and the Cochrane Library until August 2022. Two reviewers independently evaluated the risk of bias of included studies. Stata Software version 17.0 was used for the analysis. All complications reported in the literature are divided into acute phase complications and long-term complications. Overall pooled purpura, edema, crusting, blistering, hyperpigmentation, hypopigmentation, and scarring rates were 98.3%, 97.6%, 21.5%, 8.7%, 12.8%, 0.9%, and 0.2%, respectively. Although the acute adverse reactions were found to be common, the long-term permanent complications clearly have a lower frequency, and the occurrence of scarring is much lower than that initially thought. This indicates that effective protective measures after treatment are very important for preventing scar formation. Overall, PDL treatment for PWS shows a high level of safety and low chances of causing long-term complications.

Efficacy and influential factors of hematoporphyrin monomethyl ether mediated photodynamic therapy in the treatment for port-wine stains

BackgroundsHematoporphyrin monomethyl ether mediated photodynamic therapy (HMME-PDT) has emerged as an alternative approach for port-wine stain (PWS), which was primarily treated with pulsed dye laser (PDL). This study was aimed to evaluate the efficacy and safety of HMME-PDT for PWS and to explore influential factors on the efficacy. MethodsA total of 254 patients were enrolled. Patients received an intravenous injection of HMME at 5 mg/kg. Lesion areas were irradiated with 532-nm light for 20–25 min. Efficacy was assessed according to fading of lesions and graded as excellent (≥90 %), good (60 %–89 %), fair (20 %–59 %), or poor (<20 %). Adverse events were recorded. Clinical data were analyzed including gender, age, lesion sub-type, lesion location and number of treatments. ResultsOverall, 72.4 % of patients achieved an effective response, with 27.6% showing excellent efficacy, 24.8 % showing good efficacy and 20.1 % showing fair efficacy. Only 27.6 % showed poor efficacy. Patients under the age of 18 obtained a better efficacy than adults. Lesions in face showed a better therapeutic outcome than those in neck or trunk and extremities. A more effective response was seen in pink type compared with nodular thickening type. Multiple HMME-PDT treatments could improve the clinical response. Lesion location, lesion sub-type, number of treatments were independent influential factors on efficacy. Adverse events included edema, blister, crust, hypopigmentation, hyperpigmentation, pain, itch and burning sensation. No severe systemic side events were observed. ConclusionsHMME-PDT was effective for treating PWS and was safe and well-tolerated by patients. It is worth further investigation in efficacy and safety involving more patients from medical institutions in different regions in China. The optimal treatment parameters and treatment protocols are still being explored in the clinical treatment for PWS.

Pyogenic Granuloma After Treatment of Port-Wine Stain With Hemoporfin-Mediated Photodynamic Therapy.

Pyogenic Granuloma After Treatment of Port-Wine Stain With Hemoporfin-Mediated Photodynamic Therapy.

Effect of Hemoporfin-mediated photodynamic therapy in the treatment of facial port-wine stains on intraocular pressure

BackgroundPhotodynamic therapy (PDT) is a potential treatment for port-wine stains (PWS), but its effects on intraocular pressure (IOP) have not been reported. This study evaluated the efficacy of PDT for facial PWS and analyzed the changes in IOP before and after treatment. MethodsData from 32 patients with facial PWS who underwent single PDT treatment at our department were collected. The patients were divided into three groups based on the location of the PWS. Group A (15 cases) involved the eyelid of the eye being measured; Group B (10 cases) was located near the eyes but did not involve the measured eyelid; and Group C (7 cases) was situated on the face but not near the eyes. IOP measurements were taken before and after treatment, and the efficacy and changes in IOP were analyzed. ResultsThe overall efficacy rates of single PDT were 84.37 %, demonstrating superior efficacy for the pink type, age < 6 years, and skin lesions < 10 cm2 (P < 0.05). The higher IOP was observed on the side with eyelid involvement of PWS (P < 0.001). The IOP of the affected side in Group A decreased by 2.13 ± 2.10 mmHg on average after treatment, which was statistically significant compared with the other two groups (P<0.05). ConclusionsEyelid involvement in PWS increases the risk of elevated IOP. Hemoporfin-mediated PDT can reduce the IOP in patients with PWS involving the eyelid within a safe range. PDT for facial PWS is considered to be safe and effective.

Pulsed dye laser (PDL) versus photodynamic therapy (PDT) for the treatment of port wine stain (PWS): a systematic review and meta-analysis

Objective: Vascular lesions, such as port wine stain (PWS), lead to facial and psychological problems that require careful and timely treatments. This review aims to compare two mainstream methods pulsed dye laser (PDL) therapy and photodynamic therapy (PDT) for PWS. Methods: The Cochrane Library, PubMed, Embase, CNKI Full-Text Chinese Database and VIP Chinese Scientific Journals Database were searched for literatures comparing PDL versus PDT in treating PWS with no dates set. Studies were eligible for inclusion if they were randomised, placebo-controlled or head-to-head trials published in either English or Chinese. The primary outcome was overall response rate judged by physician/investigator-reported outcome scoring system. Adverse effects were also recorded. Review Manager (RevMan) was used to perform data synthesis. Cochrane risk of bias tool was used for methodological quality assessment. Retrospective studies were assessed based on Newcastle-Ottawa Scale. Results: Twelve studies met the inclusion criteria, among which eight studies had the data necessary for the meta-analysis. Among the eight studies, four were retrospective studies with 1,075 patients. The other four were RCT studies with 532 randomised participants. Regarding the overall response rate of RCT studies, PDT demonstrated no significantly higher efficacy than PDL with RR 0.76 (95% credible interval [CI] 0.48–1.20). Regarding purple types, the overall response rate of PDT was statistically significantly superior to that of PDL with RR of 0.47 (95% CI: 0.29–0.79). In terms of red types, PDT also manifested no significantly higher efficacy compared with PDL with RR of 0.85 (95% CI: 0.27–2.71). Conclusion: PDT is an effective and safe treatment for different types of PWS and was more effective than PDL in treating purple type of PWS.

Efficacy of hemoporfin-PDT on port-wine stains: A retrospective analysis of 2952 cases

ObjectiveTo conduct a retrospective analysis of Hemoporfin photodynamic therapy (HMME-PDT) in the treatment of port-wine stains (PWS). MethodA retrospective analysis was conducted based on the clinical data from March 2017 to December 2022, so as to summarize the demographic characteristics, clinical efficacy and adverse reactions. The effectiveness of HMME-PDT was examined with respect to treatment times, age, gender, subtype, and location of PWS lesions. ResultThe age of the 2952 cases ranged from 8 months to 56 years old (median, 2.8 years), with 1419 males (48.07 %), and 1533 females (51.93 %). There were 669 cases of pink type (22.66 %), 2184 cases of purplish red type (73.98 %), and 99 cases of nodular thickening type (3.35 %). The prevalence location was face (88.04 %), neck (14.94 %), limbs and trunk. 1602 cases (54.27 %) had never received treatment, 661 cases (22.39 %) had been treated by pulse dye laser (PDL), 229 cases (7.76 %) had previously been treated by PDT, 296 cases (10.03 %) had received both the modalities.The 2952 cases completed totally 7996 HMME-PDT times. Cure rate and effective rate increased continuously with the number of treatments. The pink type has the highest cure rate and effective rate, followed by the purplish red type and the last was the nodular thickening type. The therapeutic effects are considerably influenced by age, subtype, and treatment site (P < 0.05). However, there was no significant difference in the effectiveness of HMME-PDT between both genders.The local adverse reactions after the first treatment included edema (97.73 %), itching (82.62 %), purpura-like change (79.51 %), crusts (24.59 %), infection (4.07 %), scars (1.08 %), hyperpigmentation (0.61 %), and depigmentation (0.41 %). Nausea and vomiting occurred in 2 juveniles and 1 young adult (5, 6 and 22 years old respectively) immediately after treatment, and did not interfere with the administration of the treatment. Patients aged 21–30 were found to have a 3.4-fold higher likelihood of undergoing HMME-PDT under general anesthesia compared to those aged 15 or younger. There was no distinct systemic adverse reaction, such as allergic responses, cardiovascular effects, neurological symptoms, hematological abnormalities, respiratory symptoms, or musculoskeletal issues. ConclusionHMME-PDT is preferred in treating PWS, with relatively high effective rate and cure rate, mild local reactions and no distinct systemic adverse reaction.

TikTok as a Source of Medical Information: Port Wine Stain Birthmarks and Treatment Using Vascular Lasers.

As social media usage grows, more patients are turning to various platforms to gain and share medical information. One platform, TikTok, has become immensely popular, with over one billion users. Despite its potential use as an educational tool, TikTok can be unreliable and misleading as a medical information source. We aim to discuss the information available on TikTok regarding laser treatment for port wine stains (PWS). Two independent reviewers analyzed 200 TikTok videos with the hashtags #portwinestainlaser or #portwinestaintreatment, examining the video creator's role (e.g., patient, parent, physician, or other), tone towards PWS and treatment options, and content (e.g., educational or non-educational, mention of any treatment risks). Most videos were produced by non-medical professionals (83%), and only a small number discussed the potential adverse effects of PWS treatment options (15%). While TikTok may have a role in educating patients about certain dermatologic conditions and treatment options, it is important to encourage patients to seek medical advice from a qualified medical professional before making any treatment decisions.Furthermore, the future of patient education may need to evolve to include social media platforms.

Tissue optical clearing enhances efficacy of vascular targeted photodynamic therapy of mouse dorsal skin

Vascular-targeted photodynamic therapy (V-PDT) is an effective treatment for port wine stains (PWS). However, repeated treatment is usually needed to achieve optimal treatment outcomes, possibly due to the limited treatment light penetration depth in the PWS lesion. The optical clearing technique can increase light penetration in depth by reducing light scattering. This study aimed to investigate the V-PDT in combination with an optical clearing agent (OCA) for the therapeutic enhancement of V-PDT in the rodent skinfold window chamber model. Vascular responses were closely monitored with laser speckle contrast imaging (LSCI), optical coherence tomography angiography, and stereo microscope before, during, and after the treatment. We further quantitatively demonstrated the effects of V-PDT in combination with OCA on the blood flow and blood vessel size of skin microvasculature. The combination of OCA and V-PDT resulted in significant vascular damage, including vasoconstriction and the reduction of blood flow. Our results indicate the promising potential of OCA for enhancing V-PDT for treating vascular-related diseases, including PWS.

Influential Factors in the Efficacy of Hemoporfin-Mediated Photodynamic Therapy for Port-wine Stains.

Hemoporfin-mediated photodynamic therapy (HMME-PDT) is commonly used in the treatment of port-wine stains (PWS). However, the influential factors for the efficacy of the treatment are not well defined. This study intends to observe the influential factors for the efficacy of HMME-PDT in the treatment of port-wine stains (PWS). A total of 551 patients with PWS of head and neck was enrolled in this retrospective study. Further screening the patients of facial PWS, 484 patients were chosen. Patients were treated with HMME-PDT. All patients received 1~3 sessions of treatment with 2~3-month intervals. We photographed the lesions before each session and 2~3 months after the last session. Ages, sessions, lesion subtypes, and previous treatment history were related to the response of HMME-PDT (P =0.032, P<0.001, P=0.012, P=0.003 respectively). Treatment sessions were the independent factor correlated with efficacy after 3 sessions of treatment. Patients with no treatment history targeting PWS showed higher efficacy than those were treated with laser or other photodynamic treatment (P<0.05). The efficacy was higher by increasing the sessions of treatment. The efficacy was higher for lesion on maxillary prominence area and mandibular prominence area that on frontonasal prominence area and optic vesicle area (P<0.05). HMME-PDT is an effective in the treatment of PWS. Patients received no previous treatment for PWS, total treatment sessions and lesion on maxillary prominence area and mandibular prominence area are positive factors.

Hemoporfin-Mediated Photodynamic Therapy for Port-Wine Stains on Extremities.

Pulsed dye laser (PDL) is currently considered to be the first-line treatment for port-wine stains (PWSs) on the extremities despite its less than satisfactory therapeutic efficacy. Hemoporfin-mediated photodynamic therapy (HMME-PDT) is a vascular-targeted therapy that has rarely been used to treat PWSs on the extremities. Here, we evaluate the clinical efficacy and safety of HMME-PDT for the treatment of PWSs on the extremities. Clinical data and dermoscopic images of PWSs on the extremities were obtained from 65 patients who underwent HMME-PDT between February 2019 and December 2022. The clinical efficacy of HMME-PDT was analyzed by comparing the pre- and post-treatment images. The safety of HMME-PDT was evaluated through observation during the treatment period and post-treatment follow-up. The efficacy rate of a single HMME-PDT session was 63.0% and that of two and three to six sessions was 86.7% and 91.3%, respectively. A positive correlation was found between therapeutic efficacy and the number of HMME-PDT sessions. The therapeutic efficacy of HMME-PDT was better on the proximal extremities than on other parts of the extremities (P = 0.038), and the efficacy of treating PWSs in each site was relatively improved with an increase of treatment time. The clinical efficacy of HMME-PDT differed across four PWS vascular patterns identified by dermoscopy (P = 0.019). However, there was no statistical difference in the therapeutic efficacy based on age, sex, type of PWS, and treatment history (P > 0.05), which may bepartlyattributed to the relatively small sample size or poor cooperation of infant patients. No obvious adverse reactions were observed during the follow-up period. HMME-PDT is a very safe and effective treatment for PWSs on the extremities. Multiple HMME-PDT treatments, lesions located in proximal limbs, and PWSs with type I and IV vascular patterns under dermoscopy were associated with higher efficacy of HMME-PDT. Dermoscopy may help predict the clinical efficacy of HMME-PDT. 2020KJT085.

A review of treatment of port-wine stains with pulsed dye laser in fitzpatrick skin type IV-VI.

Port-Wine Stains are a congenital vascular malformation that affect 0.3-0.5% of newborns. It is a benign capillary malformation that commonly occurs on the head and neck. It is formed by progressive dilation of the post-capillary venules, and as the patient ages it may be associated with hypertrophy and nodularity which can lead to cosmetic disfigurement and psychological aggravation. There are many choices of treatment such as cryosurgery, cosmetic tattooing, and dermabrasion, amongst others. The treatment of choice is pulse dye laser (PDL) because it is both effective and safe to use.In darker skin types (Fitzpatrick skin types IV-VI), treatment is more difficult. Caution when treating darker skin types with PDL comes from the fact that there is an inverse correlation between vessel specificity of the PDL and skin pigmentation. In this review, we will be reviewing the literature and discussing the manuscripts that describe the treatment of PWS on patients with fitzpatrick skin type IV-VI. Authors searched the PubMed Medline in the English language from database inception through December 2022 for eligible articles. The keywords searched included "PDL," "pulse dye laser," "skin of color," "Fitzpatrick skin types IV-VI," "fitzpatrick," "pigmented skin," "Port-wine stain," "PWS", and "pulse dye laser." The articles that were included discussed PDL in the treatment of PWS in patients of skin of color. Any additional similar articles that were cited in our search were also included. Articles that were excluded did not discuss Fitzpatrick skin types IV-VI, darker skin type, or PDL. Data collected from each article included the number of participants, Fitzpatrick skin type, age, and laser parameters. There were 120 articles that were reviewed from our search and a total of nine articles met inclusion criteria with 241 patients that were considered Fitzpatrick skin type IV-VI. The patients were of a wide range of ages from 1month to 74years old. In our review, patients who are treated at a younger age had better results than when treated at an older age. The results show that darker skin individuals have better results when treated at a younger age compared to adults, they can experience complete resolution. Adults who were treated saw a variation of results, from improvements in the appearance to hyperpigmentation/hypopigmentation or scarring of the treated area. Patients who are Fitzpatrick skin type IV-VI are at higher risk of adverse events when treated with PDL for PWS when compared to patients of other skin types. Studies show that PDL can be beneficial for PWS in patients of skin of color; however, there are risks of hyperpigmentation, hypopigmentation, and scarring that are important to take into consideration when treating these patients. Further research is warranted to improve the understanding of PDL for PWS in patients of skin of color.

Hemoporfin-mediated photodynamic therapy with general anesthesia showed superior efficacy in the treatment of port-wine stains: a retrospective evaluation.

Hemoporfin-mediated photodynamic therapy (PDT) is an effective treatment for port-wine stains (PWS), and pain is the main adverse effect of this therapy. General anesthesia is commonly used for pain management during PDT, but the effect of general anesthetics on the subsequent treatment efficacy of PDT in PWS has not been reported. To assess the use of general anesthesia combined with PDT compared with PDT alone in 207 PWS patients, and to provide further safety and efficacy data on this combined therapy. Propensity score matching (PSM) was used at a 2:1 ratio to create a general anesthetic group (n = 138) and a highly comparable nonanesthetic group (n = 69). The clinical outcomes were evaluated, and the treatment reactions and adverse effects were recorded after one treatment with PDT. After matching, there was no significant difference in the demographic data of the patients in the two groups (p > 0.05), while the treatment efficacy was significantly higher in the general anesthetic group than in the nonanesthetic group (76.81 vs. 56.52%, p < 0.05). Moreover, logistic regression analysis confirmed that patients receiving general anesthesia showed an association with a good response to PDT (OR = 3.06; 95% CI, 1.57-6.00; p = 0.0011). Purpura lasted longer in the general anesthetic group, but the other treatment reactions and adverse effects were similar in the two groups (p > 0.05). No serious systemic adverse reactions were observed. We recommend this combined therapy, which is associated with painless, as a high efficacy treatment option for PWS patients, especially for patients with a poor response to multiple PDT alone treatments.

Time interval between pulse dye laser treatments of port-wine stains: 30 years of experience

ABSTRACT Port-wine stains (PWS) are frequently refractory to laser treatments. The aim of this study is to evaluate the role of treatment interval time. From 1990, 216 patients underwent Pulsed Dye Laser sessions. The laser sessions were scheduled at a minimum interval of 4 weeks to a maximum of 48 weeks. Clinical outcomes were assessed 8 weeks after the last laser session. Better results were obtained with 8 weeks interval time between therapy session, and high efficacies were also found for intervals of 4, 6 and 10 weeks. For greater interval instead, the effectiveness is significantly lower.

DERMOSCOPY FEATURES OF PORT-WINE STAINS: THE FIRST STUDY OF 148 CASES IN VIET NAM

Introduction: Port-wine stains (PWS) are capillary malformation affecting 0.3% to 0.5% of the population. In Vietnam, the dermoscopic features of PWS have not been systematically studied.Objectives: The aim of this study was to analyze the dermoscopic images of 148 patients with PWS. Methods: 148 cases with PWS were analyzed basing on dermascopic images.Results: The most common vascular images were dots or globules vessels (76.4%) and linear vessels (68.9%). Sausage-like vessels and whitish veils were more common in the group of patients aged older than 18 years or with purple type of PWS. For all the dermoscopic features of PWS, excluding linear vessels, there were no significant differences between lesions located in the central facial area and peripheral facial area (p &gt; 0.05). Compared with the peripheral facial lesions, linear vessels were more common in central facial lesions (p &lt; 0.05). Conclusion: Dermoscopy may provide very useful clinical information before laser treatment of PWS. The vascular manifestations of PWS determined by dermoscopy may correlate with age, colour, location and response to laser treatment.

Mapping port wine stain in vivo by optical coherence tomography angiography and multi-metric characterization.

Port wine stain (PWS) is a congenital cutaneous capillary malformation composed of ecstatic vessels, while the microstructure of these vessels remains largely unknown. Optical coherence tomography angiography (OCTA) serves as a non-invasive, label-free and high-resolution tool to visualize the 3D tissue microvasculature. However, even as the 3D vessel images of PWS become readily accessible, quantitative analysis algorithms for their organization have mainly remained limited to analysis of 2D images. Especially, 3D orientations of vasculature in PWS have not yet been resolved at a voxel-wise basis. In this study, we employed the inverse signal-to-noise ratio (iSNR)-decorrelation (D) OCTA (ID-OCTA) to acquire 3D blood vessel images in vivo from PWS patients, and used the mean-subtraction method for de-shadowing to correct the tail artifacts. We developed algorithms which mapped blood vessels in spatial-angular hyperspace in a 3D context, and obtained orientation-derived metrics including directional variance and waviness for the characterization of vessel alignment and crimping level, respectively. Combining with thickness and local density measures, our method served as a multi-parametric analysis platform which covered a variety of morphological and organizational characteristics at a voxel-wise basis. We found that blood vessels were thicker, denser and less aligned in lesion skin in contrast to normal skin (symmetrical parts of skin lesions on the cheek), and complementary insights from these metrics led to a classification accuracy of ∼90% in identifying PWS. An improvement in sensitivity of 3D analysis was validated over 2D analysis. Our imaging and analysis system provides a clear picture of the microstructure of blood vessels within PWS tissues, which leads to a better understanding of this capillary malformation disease and facilitates improvements in diagnosis and treatment of PWS.