Description and Analysis of Treatments for Port-wine Stain Birthmarks

Background and Objectives: Previous in vitro studies demonstrated the potential utility of benzoporphyrin derivative monoacid ring A (BPD) photodynamic therapy (PDT) for vascular destruction. Moreover, the effects of PDT were enhanced when this intervention was followed immediately by pulsed dye laser (PDL) irradiation (PDT/ PDL). We further evaluate vascular effects of PDT alone, PDL alone and PDT/PDL in an in vivo rodent dorsal skinfold model. Study Design/Materials and Methods: A dorsal skinfold window chamber was installed surgically on female Sprague-Dawley rats. One milligram per kilogram of BPD solution was administered intravenously via a jugular venous catheter. Evaluated interventions were: control (no BPD, no light), PDT alone (576 nm, 16 minutes exposure time, 15 minutes post-BPD injection, 10 mm spot), PDL alone at 7 J/cm 2 (585 nm, 1.5 ms pulse duration, 7 mm spot), PDL alone at 10 J/cm 2 , PDT/PDL (PDL at 7 J/cm 2 ), and PDT/PDL (PDL at 10 J/cm 2 ). To assess changes in microvascular blood flow, laser speckle imaging was performed before, immediately after, and 18 hours post-intervention. Results: Epidermal irradiation was accomplished without blistering, scabbing or ulceration. A reduction in perfusion was achieved in all intervention groups. PDT/PDL at 7 J/ cm 2 resulted in the greatest reduction in vascular perfusion (56%). Conclusions: BPD PDT can achieve safe and selective vascular flow reduction. PDT/PDL can enhance diminution of microvascular blood flow. Our results suggest that PDT and PDT/PDL should be evaluated as alternative therapeutic options for treatment of hypervascular skin lesions including port wine stain birthmarks. Lasers Surg. Med.

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“…Port wine stain (PWS) birthmarks are amenable to PDL treatment; however, the blanching response is variable and unpredictable [2].…”

Section: Introductionmentioning

confidence: 99%

Microvascular blood flow dynamics associated with photodynamic therapy, pulsed dye laser irradiation and combined regimens

et al. 2006

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“…90 The PDLinduced wound healing response may lead to new vessel formation. 89,91 Phung et al 89 showed that normal skin treated with a combination of PDL and daily topical application of sirolimus for 14 days showed a decrease in reformation and reperfusion of vessels as compared to skin treated with PDL alone. Kelly et al 92 randomly assigned subjects with PWS to treatment protocols using either PDL plus imiquimod or PDL plus placebo.…”

Section: Hemangioendotheliomas Key Point D Antiangiogenic Treatment Hmentioning

confidence: 99%

Angiogenesis in cutaneous disease: Part II

Laquer

Hoang

Nguyen

et al. 2009

Journal of the American Academy of Dermatology

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This review will discuss the role of angiogenesis in specific cutaneous diseases. Scientific evidence now points to the role of angiogenesis in tumor development and many other cutaneous disorders. Angiogenesis is a complex process that involves angiogenic growth factors and inhibitors, many of which could be a potential target for pharmacologic intervention. Antiangiogenic agents have recently been applied to dermatologic diseases with promising efficacy. ( J Am Acad Dermatol 2009;61:945-58.)Learning objectives: After completing this learning activity, participants should be able to recognize cutaneous diseases where angiogenesis is likely to be an important factor, recognize scenarios where angiogenic therapy may be useful in conjunction with traditional therapies, and be able to use angiogenicmediating agents in the treatment of dermatologic disease.

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“…Such extensive experience with photodynamic therapy (PDT) for port wine stains (PWS) is impressive and I believe, unequaled in the Western world. In the United States and Europe, pulsed lasers and light sources, especially the pulsed dye laser (PDL; wavelengths = 585 or 595 nm) are the treatment of choice for PWS and it is unusual for other treatment modalities to be utilized [2]. However, physicians familiar with PDL therapy for PWS agree that while dramatic results can be achieved, many lesions are resistant and complete removal is uncommon.…”

Section: Introductionmentioning

confidence: 99%