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Comparison of different non-invasive diagnostic techniques used for HMME-PDT in the treatment of port wine stains
摘要： Background: Hemoporfin-mediated photodynamic therapy (HMME-PDT) is an effective method for treating port wine stains (PWS). While, it still lacks methods to evaluate the treatment of HMME-PDT for PWS effectively and objectively. Objective: This study aimed to compare the value of different non-invasive diagnostic techniques used for HMME-PDT treatment evaluation in PWS. Methods: Thirty-one lesions of 22 patients with PWS were treated with HMME-PDT. Four non-invasive diagnostic techniques including VISIA-CRTM system, dermoscopy, high-frequency ultrasound (HFUS) and laser speckle imager (LSCI) were used to obtain standard radiographic data containing skin color, skin thickness, blood vessel morphology, blood vessel distribution and blood perfusion from lesions and normal skin surrounded before and after HMME-PDT. Results: The standard image pattern of VISIA-CRTM system showed color change of the lesions of PWS after HMME-PDT. RBX-red image of VISIA-CRTM system showed that erythema was highly aggregated even on invisible lesions at baseline but decreased after HMME-PDT. The erythema index reduced value d was related to the efficacy rating (γ=0.631, P＜0.05). Dermoscopy showed that the number of spot-like and irregular linear vessels increased correlated with increase of clinical classification. After HMME-PDT, vascular rupture was observed by dermoscopy. The response rate of lesions with vascular rupture was 100.00% (20/20). And the response rate of lesions without vascular rupture was 63.64% (7/11). Vascular rupture sign was correlated with better efficacy (P＜0.05). High-frequency ultrasound showed that dermis of PWS thickened and arranged loosely with scattered linear hypoechoic signal. After HMME-PDT, the dermal layer of the lesions became thinner with the linear hypoechoic signal decreased. The response rate of lesions with linear hypoechoic signal was 76.92% (10/13), and that without linear hypoechoic signal was 94.44% (17/18). The lesions without linear hypoechoic signal in dermis showed better efficacy (P＜0.05). In some lesions, Laser speckle contrast showed high blood perfusion signal in PWS lesions and a blood perfusion reduction after HMME-PDT. Conclusion: VISIA-CRTM system can be used to observe not only visible but also invisible lesions of PWS. Moreover, lesions fading after HMME-PDT treatment can be described objectively by VISIA-CRTM system. Dermoscopy played an important role in the clinical classification of PWS, including assessing vascular injury after HMME-PDT, guiding the adjustment of therapeutic dose, and selecting the end point of treatment. HFUS and LSCI can be both used to assist the treatment response evaluation of HMME-PDT.
关键词： dermoscopy,port-wine stains,laser speckle contrast imaging,hemoporfin-mediated photodynamic therapy,VISIA-CRTM system,high-frequency ultrasound
更新于2025-09-23 15:23:52
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Harper's Textbook of Pediatric Dermatology || Laser Therapy
摘要： The pulsed dye laser has revolutionized the treatment of vascular anomalies. More recently, the multiplex laser, a combination of pulsed dye and Nd:YAG, has been shown to be beneficial for recalcitrant port wine stains and other conditions. In addition to their use in treating port wine stains, lasers have also an important role in treating a number of childhood pigmentary disorders. These are primarily congenital naevi such as café‐au‐lait macules, naevus of Ito and some blue lesions. Laser treatment is based on selective thermal destruction or damage to a targeted chromophore located in the skin, either that of blood, melanin or tissue water. Lasers have been shown to successfully treat vascular and pigmented lesions and also remove unwanted hair. They can also be used to remove verrucous lesions such as angiofibromas and epidermal naevi through vaporization.
关键词： pulsed dye laser,vascular anomalies,verrucous lesions,port wine stains,hair removal,selective photothermolysis,pigmentary disorders
更新于2025-09-16 10:30:52
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Vascular and Pigmented Lesions of Phacomatosis Pigmentovascularis Treated With a Combination of Long-Pulsed, Q-Switched Laser, and Picosecond Lasers
摘要： Phacomatosis pigmentovascularis (PPV) is a rare congenital condition characterized by the coexistence of port-wine stains (PWS) and various melanocytic lesions. Treatment should be considered, given the often extensive lesions and social impact. Of the approximate 250 reported cases of PPV, only 5 cases discuss treatment options. Laser therapy is widely used and successful in treating the individual lesions often seen in PPV. However, the collision of these red and brown pigments of different depths in the dermis, often on a background of darker skin, makes treatment of these lesions challenging. This case, and a review of 4 PPV treatment cases, highlights the success of combination laser treatment and addresses factors including age and choice of anesthesia that will optimize results.
关键词： melanocytic lesions,Phacomatosis pigmentovascularis,port-wine stains,PPV,laser therapy
更新于2025-09-12 10:27:22
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The influence of morphological distribution of melanin on parameter selection in laser thermotherapy for vascular skin diseases
摘要： Port wine stains (PWSs) are congenital vascular malformations that progressively darken and thicken with age. Currently, laser therapy is the most effective way in clinical management of PWS. It is known that skin pigmentation (melanin content) affects the radiant exposure that can be safely applied to treat PWS. However, the effect of melanin distribution in the epidermis on the maximum safe radiant exposure has not been studied previously. In this study, 10 different morphological distributions of melanin were proposed according to the formation and migration characteristics of melanin, and the two-scale heat transfer model was employed to investigate the influence of melanin distribution on the threshold radiant exposure of epidermis and blood vessels. The results show that melanin distributions do have a strong effect on laser parameter selection. When uniform melanin distribution is assumed, the threshold radiant exposure to damage a typical PWS blood vessel (50 μm diameter) is 8.62 J/cm2 lower than that to injure epidermis. The optimal pulse duration is 1–5 ms for a typical PWS blood vessel of 50 μm when melanin distribution is taken into consideration. PWS blood vessels covered by non-uniformly distributed melanin are more likely to have poor response to laser treatment.
关键词： Port wine stains,Melanin distribution,Two-scale model,Cryogen spray cooling,Laser treatment
更新于2025-09-12 10:27:22
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Criteria of pressure and thermal damage during laser irradiation of port wine stains: Which is dominant to vascular lesions?
摘要： Port wine stains (PWSs) are congenital dermal vessel proliferations mainly treated with laser therapy. The complete removal of the vessel lesions is rarely achieved because of a lack of discriminatory analysis of the two competitive laser damages to blood vessels, namely, pressure damage and thermal damage. Unlike complete vessel constriction, which is caused by thermal damage that can be measured by temperature-related integral X, vessel rupture results from pressure damage, which has been seldom studied. In this study, the rupture potential index based on wall pressure (RPIP) was calculated as the ratio of locally acting pressure to the pressure threshold. RPIP > 1 and X > 103 were adopted as benchmarks to judge pressure damage (vessel rupture) and thermal damage (complete vessel constriction), respectively. A computational fluid dynamics simulation was carried out to provide the temperature and pressure field in the PWS vessel model during irradiation by 595 nm pulsed dye laser (PDL) or 1064 nm Nd:YAG laser. Numerical results showed that for the 595 nm laser, vessels constantly underwent rupture. The area of high RPIP determined the degree of rupture by predicting the large and multiple rupture locations of the vessel. By contrast, for the 1064 nm laser, complete constriction was the main damage type. To a single vessel of 100 lm diameter, the optimized laser parameters were E = 10 J/cm2 with tp = 6 ms for 595 nm PDL and E = 180 J/cm2 with tp = 6 ms 1064 nm for Nd:YAG laser.
关键词： Port wine stains,Vessel rupture,Vessel constriction,Computational fluid dynamics,Laser treatment
更新于2025-09-11 14:15:04