Adjuncts to pulsed dye laser for treatment of port wine stains: a literature review

Wang, Bing; Mei, Xianglin; Wang, Yanlong; Hu, Xin; Li, Fuqiu

doi:10.1080/14764172.2022.2052901

Cited by 4 publications

(5 citation statements)

References 52 publications

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“…However, most port wine stains are not completely cleared after pulsed dye laser therapy, owing to insufficient photocoagulation and laser-induced vascular regeneration and reperfusion. 19 Most patients did well without treatment or with elastic compression only. Surgical treatment for vascular malformations in KTS is rarely needed and it continues to be controversial.…”

Section: Discussionmentioning

confidence: 93%

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KTWS (Klippel‐Trenaunay‐Weber syndrome): A systematic presentation of a rare disease

Mofarrah,

Gooranorimi

et al. 2024

J of Cosmetic Dermatology

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BackgroundKlippel‐Trenaunay‐Weber syndrome (KTWS) is a rare disease with a wide range of manifestations. KTWS is characterized by a clinical triad of varicosities of the extremities, cutaneous vascular malformations, and hypertrophy of soft tissues and long bones. The diagnosis is made clinically supplemented with magnetic resonance imaging and computed tomography.AimHereby we aim to highlight the significance of the possible life‐threatening first‐time presentations associated with the GI system in previously undiagnosed KTWS patients.PatientWe report the case of a 47‐year‐old male with KTWS, who presented with various symptoms such as rectorrhagia since childhood, digestive problems and abnormal lateral vascular malformations of the left buttock which extended all the way to the leg, vascular malformations of the left fourth and fifth toes as well as soft tissue swelling of the left foot. There was no evidence of other clinical presentations. The patient was hospitalized with severe rectorrhagia and a hemoglobin level of 3/9. Physical examination revealed a blood pressure of 85/55 and pulse rate of 115. Ruptured aneurysm of the superior mesenteric artery was found on angiography and subsequently treated with embolization. Dermatologic evaluation showed pitting edema of the left leg and foot and multiple vascular lesions. Thus a diagnosis of KTWS was established. Pulsed dye laser therapy and compression bandage was performed for the patient. The patient's follow‐up was done 3 months after discharge for which the patient was again consulted by a dermatologist and gastroenterologist. Lymphedema of the left leg had improved to a great extend so treatment with compression bandage was continued. Colonoscopy was repeated for the patient to evaluate and control possible active sources of bleeding, due to potential life‐threating complications.ResultsAccording to previous findings, there have been few case reports of KTWS presenting with gastrointestinal manifestations, fewer of which have covered acute life‐threatening bleedings associated with this system.

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Section: Discussionmentioning

confidence: 93%

“…Noninvasive pulsed dye laser is the current gold standard for the treatment of port wine stains. However, most port wine stains are not completely cleared after pulsed dye laser therapy, owing to insufficient photocoagulation and laser‐induced vascular regeneration and reperfusion 19 …”

Section: Discussionmentioning

confidence: 99%

KTWS (Klippel‐Trenaunay‐Weber syndrome): A systematic presentation of a rare disease

Mofarrah,

Gooranorimi

et al. 2024

J of Cosmetic Dermatology

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“…There are some adjuvant treatments which have been tried with PDL, although none have achieved marked improvement over laser therapy alone and are no longer used frequently in clinical treatments ( Wang et al, 2022 ). Combination of PDL with topical imiquimod demonstrated slightly improved effect in treating PWB over PDL alone in small scale studies through immunomodulation activity that reduces tumor necrosis factor (TNF), interferon-γ (IFN-γ), as well as decreasing pro-angiogenic production of matrix metalloproteinase 9 (MMP9) and increasing apoptosis ( Sidbury et al, 2003 ; Lipner, 2018 ; Wang et al, 2022 ).…”

Section: Sturge-weber Syndromementioning

confidence: 99%

“…Rapamycin, an mTOR inhibitor, has been studied in a variety of diseases for its immunosuppressant and antiproliferative activities. Human clinical studies of topical rapamycin combined with PDL on affected areas of the face and neck showed some efficacy in limiting cutaneous vessel regrowth via HIF-1α and VEGF inhibition, but results were disappointing with wider clinical use ( Lipner, 2018 ; Wang et al, 2022 ). Using animal models, PDL and axitinib, an inhibitor of MEK/ERK, have been shown to prevent vessel regrowth ( Gao et al, 2015 ).…”

Section: Sturge-weber Syndromementioning

confidence: 99%

GNAQ mutations drive port wine birthmark-associated Sturge-Weber syndrome: A review of pathobiology, therapies, and current models

Trigt

Kelly

Hughes

2022

Front. Hum. Neurosci.

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Port-wine birthmarks (PWBs) are caused by somatic, mosaic mutations in the G protein guanine nucleotide binding protein alpha subunit q (GNAQ) and are characterized by the formation of dilated, dysfunctional blood vessels in the dermis, eyes, and/or brain. Cutaneous PWBs can be treated by current dermatologic therapy, like laser intervention, to lighten the lesions and diminish nodules that occur in the lesion. Involvement of the eyes and/or brain can result in serious complications and this variation is termed Sturge-Weber syndrome (SWS). Some of the biggest hurdles preventing development of new therapeutics are unanswered questions regarding disease biology and lack of models for drug screening. In this review, we discuss the current understanding of GNAQ signaling, the standard of care for patients, overlap with other GNAQ-associated or phenotypically similar diseases, as well as deficiencies in current in vivo and in vitro vascular malformation models.

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“…Based on the clinical manifestations, PWSs are divided into three types: pink, purple, and hypertrophic. At the present time, pulsed dye laser (PDL) is the gold-standard treatment for PWSs [ 3 ]. About 15% of all patients with PWSs have these capillary malformations on the limbs.…”

Section: Introductionmentioning

confidence: 99%

Hemoporfin-Mediated Photodynamic Therapy for Port-Wine Stains on Extremities

Kang

Liu

Fang

et al. 2023

Dermatol Ther (Heidelb)

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Introduction Pulsed dye laser (PDL) is currently considered to be the first-line treatment for port-wine stains (PWSs) on the extremities despite its less than satisfactory therapeutic efficacy. Hemoporfin-mediated photodynamic therapy (HMME-PDT) is a vascular-targeted therapy that has rarely been used to treat PWSs on the extremities. Here, we evaluate the clinical efficacy and safety of HMME-PDT for the treatment of PWSs on the extremities. Methods Clinical data and dermoscopic images of PWSs on the extremities were obtained from 65 patients who underwent HMME-PDT between February 2019 and December 2022. The clinical efficacy of HMME-PDT was analyzed by comparing the pre- and post-treatment images. The safety of HMME-PDT was evaluated through observation during the treatment period and post-treatment follow-up. Results The efficacy rate of a single HMME-PDT session was 63.0% and that of two and three to six sessions was 86.7% and 91.3%, respectively. A positive correlation was found between therapeutic efficacy and the number of HMME-PDT sessions. The therapeutic efficacy of HMME-PDT was better on the proximal extremities than on other parts of the extremities ( P = 0.038), and the efficacy of treating PWSs in each site was relatively improved with an increase of treatment time. The clinical efficacy of HMME-PDT differed across four PWS vascular patterns identified by dermoscopy ( P = 0.019). However, there was no statistical difference in the therapeutic efficacy based on age, sex, type of PWS, and treatment history ( P > 0.05), which may be partly attributed to the relatively small sample size or poor cooperation of infant patients. No obvious adverse reactions were observed during the follow-up period. Conclusions HMME-PDT is a very safe and effective treatment for PWSs on the extremities. Multiple HMME-PDT treatments, lesions located in proximal limbs, and PWSs with type I and IV vascular patterns under dermoscopy were associated with higher efficacy of HMME-PDT. Dermoscopy may help predict the clinical efficacy of HMME-PDT. Trial Registration No. 2020KJT085.

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Adjuncts to pulsed dye laser for treatment of port wine stains: a literature review

Cited by 4 publications

References 52 publications

KTWS (Klippel‐Trenaunay‐Weber syndrome): A systematic presentation of a rare disease

KTWS (Klippel‐Trenaunay‐Weber syndrome): A systematic presentation of a rare disease

GNAQ mutations drive port wine birthmark-associated Sturge-Weber syndrome: A review of pathobiology, therapies, and current models

Hemoporfin-Mediated Photodynamic Therapy for Port-Wine Stains on Extremities

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