Less is more: similar efficacy in three sessions and seven sessions of pulsed dye laser treatment in infantile port-wine stain patients

Zhu, Jiafang; Yu, Wenxin; Wang, Tianyou; Chen, Yijie; Lyu, Dongze; Chang, Lei; Ma, Gang; Lin, Xiaoxi

doi:10.1007/s10103-018-2525-6

Cited by 15 publications

(20 citation statements)

References 35 publications

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“…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]…”

Section: Plos Onementioning

confidence: 99%

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

et al. 2020

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Background Valid and reliable outcome measures are needed to determine and compare treatment results of port wine stain (PWS) studies. Besides, uniformity in outcome measures is crucial to enable inter-study comparisons and meta-analyses. This study aimed to assess the heterogeneity in reported PWS outcome measures by mapping the (clinical) outcome measures currently used in prospective PWS studies. Methods OVID MEDLINE, OVID Embase, and CENTRAL were searched for prospective PWS studies published from 2005 to May 2020. Interventional studies with a clinical efficacy assessment were included. Two reviewers independently evaluated methodological quality using a modified Downs and Black checklist. Results In total, 85 studies comprising 3,310 patients were included in which 94 clinician/observerreported clinical efficacy assessments had been performed using 46 different scoring systems. Eighty-one-studies employed a global assessment of PWS appearance/improvement, of which-82% was expressed as percentage improvement and categorized in 26 different scoring systems. A wide variety of other global and multi-item scoring systems was identified. As a result of outcome heterogeneity and insufficient data reporting, only 44% of studies could be directly compared. A minority of studies included patient-reported or objective outcomes. Thirteen studies of good quality were found.

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Section: Plos Onementioning

confidence: 99%

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

et al. 2020

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“…In the first analysis, the data were unclustered to reflect the clinical reality in its broadest sense (Fig. a) . In terms of interventions, a rapid switch from the 577‐nm PDL to longer‐wavelength (585 and 595 nm) PDLs is noted.…”

Section: Resultsmentioning

confidence: 99%

Port wine stain treatment outcomes have not improved over the past three decades

Raath

Chohan

Wolkerstorfer

et al. 2019

Acad Dermatol Venereol

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Background Since the early ‘80s, the pulsed dye laser has been the standard treatment tool for non‐invasive port wine stain (PWS) removal. In the last three decades, a considerable amount of research has been conducted to improve clinical outcomes, given that a fraction of PWS patients proved recalcitrant to laser treatment. Whether this research actually led to increased therapeutic efficacy has not been systematically investigated. Objective To analyse therapeutic efficacy in PWS patients globally from 1986 to date. Methods PubMed was searched for all available PWS trials. Studies with a quartile percentage improvement scale were included, analysed and plotted chronologically. Treatment and patient characteristics were extracted. A mean clearance per study was calculated and plotted. A 5‐study simple moving average was co‐plotted to portray the trend in mean clearance over time. The data were separately analysed for multiple treatment sessions in previously untreated patients. Results Sixty‐five studies were included (24.3% of eligible studies) comprising 6207 PWS patients. Of all patients, 21% achieved 75–100% clearance. Although a few studies reported remarkably good outcomes in a subset of carefully selected patients, there was no upward trend over time in mean clearance. Conclusion The efficacy of PWS therapy has not improved in the past decades, despite numerous technical innovations and pharmacological interventions. With an unwavering patient demand for better outcomes, the need for development and implementation of novel therapeutic strategies to clear all PWS is as valid today as it was 30 years ago.

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“…tive study of East Asian infants found that frequent PDL treatments (2-week intervals) did not necessarily increase efficacy and resulted in more side effects such as eczematous dermatitis 27. This may be attributed to the increased melanin in East Asian skin.…”

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confidence: 98%

Light‐based treatment of pediatric port‐wine birthmarks

Tran

Kelly

Drolet

et al. 2020

Pediatric Dermatology

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Port-wine birthmarks (PWBs), often referred to as port-wine stains or capillary malformations, are progressive malformations composed of capillaries and post-capillary venules. They occur in up to 0.3% of newborns, present at birth as a pink to red patch, and often involve cosmetically sensitive areas including the face. 1 Over time, many PWBs darken in color, acquire secondary changes, including nodules and pyogenic granulomas, and develop soft-tissue hypertrophy that may involve underlying structures. 2,3 PWBs are now known to be caused by somatic mosaic mutations in genes that control cell-cycle regulation, including GNAQ, GNA11, PiK3CA, and others that are also implicated in cell-cycle signaling. 4 This finding has transformed our fundamental understanding of their pathophysiology, as these genes share oncogenic pathways that result in synchronous, tightly regulated cellular proliferation and growth. PWB can be isolated, or syndrome-associated, including Sturge-Weber syndrome (SWS), phakomatosis pigmentovascularis (PPV), or PiK3CA-related overgrowth syndromes (PROS). Genotypephenotype correlations exist for the most common mutations in vascular stains (GNAQ, GNA11, and PiK3CA hot spot, Figure 1). 4 While detailed mechanisms are not yet characterized, causative gain-offunction somatic mosaic mutations may explain the progressive development of nodularity, soft-tissue hypertrophy, and secondary vascular change of PWBs. [4][5][6] Given the progressive disfigurement associated with PWBs, parents often seek early treatment with laser and other light-based modalities. Early treatment of PWBs reduces the likelihood and severity of disfigurement and psychosocial morbidity. 3,7 In particular, the development of vascular-selective lasers led to a therapeutic shift in the management of PWBs and remains the first-line standard of treatment. In this article, we review principles of light-based treatment for pediatric port-wine birthmarks. | Selective photothermolysisThe use of lasers to treat vascular lesions relies on the theory of selective photothermolysis (SP); chromophores or light-absorbing targets can be targeted, heated, and damaged with minimal injury to the surrounding structures (Figure 2A). 8 For PWBs, the light-absorbing targets are oxyhemoglobin (absorption peaks at 418, 542, and 577 nm), deoxyhemoglobin (absorption peak between 750 and 800 nm), or methemoglobin (absorption at 620 nm, Figure 2B). 9 Three elements are necessary to achieve desired clinical effects in PWB lesions. First, the wavelength chosen must be preferentially

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Less is more: similar efficacy in three sessions and seven sessions of pulsed dye laser treatment in infantile port-wine stain patients

Cited by 15 publications

References 35 publications

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

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

Port wine stain treatment outcomes have not improved over the past three decades

Light‐based treatment of pediatric port‐wine birthmarks

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