Immediate post‐irradiation dermoscopic vascular changes versus purpura as a therapeutic endpoint in pulsed‐dye laser treatment of port wine stains

Abstract

Pulsed‐dye laser (PDL) is the treatment of choice for port wine stain (PWS), and the development of purpura is considered a therapeutic endpoint. Changes in PWS vasculature observed by dermoscopy immediately after laser irradiation have been suggested to predict the minimal effective fluence. The current study aimed at comparing these changes with purpura as a therapeutic endpoint. Fifty‐six PWS patients, randomized into two groups, received five monthly PDL sessions (595 nm and 10 mm spot size). At the first visit, patients received multiple gradually increasing test irradiations. Patients in the first group were treated with the lowest dose that resulted in 24‐hr‐lasting purpura, while patients in the second group were treated with the lowest dose that resulted in vessel disappearance observed by dermoscope. No statistically significant differences were observed between the two groups (the dermoscopic and the purpuric) regarding mean average improvement (42.4 and 37.32%, respectively, p = .32), grade of improvement (p = .44), and the rate of side effects (0 and 13.79%, respectively, p = .13). In conclusion, the immediate post‐irradiation vessel disappearance (detected by dermoscope) is comparable, in safety and efficacy, to purpura as a therapeutic endpoint and maybe more time‐saving and more accepted cosmetically.

Clinical outcome measures and scoring systems used in prospective studies of port wine stains: A systematic review

“…Five studies (5.9%) were placebo-controlled. Thirty-two percent (N = 28/85) of studies was randomized (i.e., randomization of treatments to different patients or to different sites within one patient and/or PWS) [ 11 , 31 , 36 , 39 , 41 – 59 , 61 , 62 , 81 , 92 , 103 ]. Of the uncontrolled (noncomparative) studies (N = 42/75 [ 63 – 69 , 71 – 80 , 82 – 91 , 93 – 102 , 104 – 108 ]), 11 were performed to correlate, develop, or validate an instrument or analysis technique (such as laser speckle imaging; intended for measuring lesion characteristics, treatment effects, or efficacy), 1 study investigated different clinical assessment methods, and 1 study correlated PWS characteristics and demographic parameters with treatment results.…”

“…of studies was randomized (i.e., randomization of treatments to different patients or to different sites within one patient and/or PWS) [11,31,36,39,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]61,62,81,92,103]. Of the uncontrolled (noncomparative) studies (N = 42/75 [63][64][65][66][67][68][69][71][72][73][74][75][76][77][78][79][80][82][83][84][85][86][87]…”

Hematoporphyrin Monomethyl Ether Photodynamic Therapy of Port Wine Stain: Narrative Review

“…Another study found that the immediately dermoscopy performance after HMME-PDT, which showed vascular rupture, punctate or globular hemorrhage shadow, indicating a better later efficacy. 25 , 26 That may be a predictive marker of efficacy.…”

Noninvasive diagnostic techniques of port wine stain

“…Immediate disappearance of vessels in the treated field was comparable to purpura as an end point in treatment of PWS with PDL. This may avoid the usage of higher fluences to obtain purpuric end point and is cosmetically more acceptable than a purpura as it takes up to 2 weeks to fade 19 …”