Assessment of Pulsed-Dye Laser Therapy for Pediatric Cutaneous Vascular Anomalies

Abstract

utaneous vascular anomalies, such as hemangiomas of infancy (HOIs), are prevalent in 5% to 10% of children and are the most common tumors of infancy. 1 Approximately 20% of these vascular anomalies result in pain, bleeding, ulceration, infection, or functional impairment with vision, feeding, or breathing necessitating medical or surgical treatment. 2 Complications from these lesions include painful ulceration, infection, bleeding, and occlusion or obstruction of vital structures such as the eyes, nose, mouth, and auditory canal. 3 Facial lesions especially can cause great cosmetic disfigurement and psychosocial morbidity, affecting the child and the parent. Fifty percent of vascular lesions are still present when the child starts primary school. Although involution can be complete in up to 50% of children by the start of school, 15% to 40% of children are left with permanent skin changes, 4 including pigment alteration, telangiectasia, atrophy, and fibrofatty residuum. 5 Port-wine stains are benign congenital vascular anomalies that are localized in the dermis and affect 0.3% to 0.5% of infants. 6 In contrast to HOIs, port-wine stains do not spontaneously involute. These lesions are characterized by an abnormal dermal plexus of layers of dilated blood vessels that increase in size with age. 7 Although port-wine stains can occur anywhere in the body, about 83% are seen in the head and IMPORTANCE Although facial vascular malformations are often treated by facial plastic surgeons, no reliable validated assessment tool exists for surgeons to assess results. OBJECTIVES To use our assessment tool to analyze results from pulsed-dye laser therapy used for pediatric facial vascular malformations, and to determine interrater reliability of our assessment tool in a standard clinical environment without the use of professional photography. DESIGN A blinded retrospective review of pediatric patients who underwent pulsed-dye laser therapy for treatment of hemangiomas of infancy (HOIs) and port-wine stains. Three pediatric otolaryngologists and facial plastic surgeons independently rated all of the pictures using our assessment tool. SETTING Tertiary care pediatric hospital. RESULTS Pulsed-dye laser therapy was performed in 22 patients, 17 with HOIs and 5 with port-wine stains. Patients with HOIs treated only by pulsed-dye laser showed, on average, a 50% to 75% improvement in color, 1% to 24%, improvement in thickness, and 1% to 24% improvement in size of the lesion. Eight patients with HOIs underwent surgery after laser therapy, and of these, 100% saw improvement in color, thickness, and size. Port-wine stains showed a 1% to 24% improvement in color and no improvement in thickness or size. Interrater reliability for questions 1 to 6 was 0.92, 0.92, 0.93, 0.91, 0.70, and 0.10, respectively. CONCLUSIONS AND RELEVANCE Currently, no standardized or validated methods exist to evaluate results from intervention of pediatric facial HOIs and port-wine stains. Our assessment tool is reliable to assess patients with HOIs and port-wine ...

Current Practices in Pediatric Dermatology Laser Therapy: An International Survey

“…Respondents use a wide variety of lasers, but PDL is by far the most popular choice. This may be in part due to the fact that vascular lesions, such as PWS and IH, represent conditions that are more commonly treated in the pediatric population [6–9]. Additionally, PDL is known to be a versatile laser that can be used to treat a variety of other cutaneous conditions, such as rosacea, scars, striae rubra, and verruca [10,11].…”

Treatment of port wine stain with Tixel ‐induced rapamycin delivery following pulsed dye laser application

“…Port wine stain (PWS) can have a substantial effect on the quality of life of the patients and their families (Kalick et al, ). Although PDL has become the treatment of choice for PWS birthmarks, only 10–20% of patients obtain full clearance of their PWS even after many PDL treatments (Anderson & Parrish, ; Goldman et al, ; Griffin et al, ; Lanigan, ; Sajan et al, ; Scherer et al, ; Tan et al, ; van der Horst et al, ). In the attempt to maximize treatment efficiency, the use of other technologies has been evaluated in many trials; 532 nm potassium titanyl phosphate laser (KTP) (Alster & Tanzi, ; Chen et al, ; Chowdhury et al, ; Frohm Nilsson et al, ; Pence, Aybey, & Ergenekon, ; Yang et al, ), long‐pulsed 1064 nm neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser, alexandrite laser‐755 nm (Carlsen et al, ; Izikson, Nelson, & Anderson, ) and the IPL (intense pulsed light) in a range of 500‐1200 nm (Babilas et al, ; Faurschou, Togsverd‐Bo, Zachariae, & Haedersdal, ; Savas, Ledon, Franca, Chacon, & Nouri, ).…”

“…Resolution of PWS, as defined by persistent blanching of the lesion, is reported in less than 10–20% of cases. The revascularization is postulated to occur through post‐laser angiogenesis via the induction of hypoxia inducible factor‐1a (HIF‐1a) and VEGF pathways (Anderson & Parrish, ; Chowdhury, Harris, & Lanigan, ; Frohm Nilsson, Passian, & Wiegleb Edstrom, ; Goldman, Fitzpatrick, & Ruiz‐Esparza, ; Sajan et al, ; Scherer, Lorenz, Wimmershoff, Landthaler, & Hohenleutner, ; Tan et al, ; van der Horst, Koster, de Borgie, Bossuyt, & van Gemert, ). Sirolimus (rapamycin), a specific inhibitor of mammalian target of rapamycin, can inhibit the neo‐angiogenesis that is activated after the damage caused by PDL.…”

Treatment Outcome Measurement Instruments for Port Wine Stains: A Systematic Review of Their Measurement Properties

“…1). After reviewing 77 full-text articles, 8 studies were included [34][35][36][37][38][39][40][41]. Reference checking yielded 4 additional eligible articles: 1 was not analyzed because it was a preliminary version of another included study [42] and 3 articles with some clinimetric assessment (albeit limited in reporting and/or quality) of self-constructed questionnaires regarding PWS-related stress and stigmatization were excluded because the questionnaires proved impossible to source [6,43,44].…”