Predictive value of dermoscopy for the treatment of port‐wine stains with large spot 532 nm laser

Kwiek, Bartłomiej; Rożalski, Michał; Sieczych, Julia; Paluch, Łukasz; Kowaléwski, Cezary; Ambroziak, Marcin

doi:10.1002/lsm.23083

Cited by 24 publications

(42 citation statements)

References 18 publications

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“…Other non-invasive imaging systems that have been used or currently under development for evaluation of dermal vasculatures include laser Doppler flowmeter, laser Doppler imaging, dermoscopy, cross-polarized diffuse reflection color imaging system, and optical coherence tomography [39][40][41][42][43][44][45][46][47][48]. The main feature of RCM is that it can directly reveal the dermal structure in a simple and fast way, which makes it be a promising bedside tool for prognostic evaluation.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Laser‐Resistant Port Wine Stain Blood Vessels Using In Vivo Reflectance Confocal Microscopy

Huang

Xiang

et al. 2019

Lasers Surg Med

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Background and Objectives Port wine stain (PWS) is a congenital vascular malformation of the human skin. Laser is the treatment of choice for PWS. Laser‐resistant PWS is one crucial factor accounting for inadequate treatment outcome, which needs to be fully characterized. This study aims to quantitatively characterize the morphology of laser‐resistant PWS blood vessels in the upper papillary dermis using in vivo reflectance confocal microscopy (RCM). Study Design/Materials and Methods A total of 42 PWS subjects receiving laser treatment from August 2016 through July 2018 were enrolled into this study. Thirty‐three subjects had facial PWS; nine had extremity PWS. All subject's PWS received multiplex 585/1,064 nm laser treatment. RCM images were taken before and after treatment. The density, diameter, blood flow, and depth of PWS blood vessels were analyzed. Results We found 44.4% PWS on the extremities (four out of nine subjects) were laser‐resistant, which was significantly higher (P < 0.001) when compared with those PWS on the face (15.2%, 5 out of 33 subjects). The laser‐resistant facial PWS blood vessels had significantly higher blood flow (1.35 ± 0.26 U vs. 0.89 ± 0.22 U, P < 0.001), larger blood vessel diameters (109.60 ± 18.24 µm vs. 84.36 ± 24.04 µm, P = 0.033) and were located deeper in the skin (106.01 ± 13.87 µm vs. 87.82 ± 12.57 µm, P < 0.001) in the skin when compared with laser‐responsive PWS on the face. The average PWS blood vessel density (17.01 ± 4.63/mm2 vs. 16.61 ± 4.44/mm2, P = 0.857) was not correlated to the laser resistance. Conclusions Laser‐resistant PWS blood vessels had significantly higher blood flow, larger diameters, and were located deeper in the skin. RCM can be a valuable tool for a prognostic evaluation on laser‐resistant lesions before treatment, thereby providing guidance for tailored laser treatment protocols, which may improve the therapeutic outcome. The limitations for this study include relative small sample size and acquisitions of different blood vessels before and after 2 months of treatment. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Characterization of Laser‐Resistant Port Wine Stain Blood Vessels Using In Vivo Reflectance Confocal Microscopy

Huang

Xiang

et al. 2019

Lasers Surg Med

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“…The diameter of a vessel may also have significant predictive value-elongated vessels with small diameters show inferior response to pulsed dye laser therapy. [4][5][6][7] Considering the price of the procedures and patients' expectations, dermoscopy as a predictive method to assess the effectiveness of the procedure using pulsed dye laser seems to be useful in clinical practice. [4][5][6][7] The correlation of dermoscopic patterns with histopathological findings could be helpful in qualification for laser procedures, as a useful tool for the differentiation of lentigo simplex and lentigo maligna and the diagnosis of other skin cancer.…”

Section: Dermoscopymentioning

confidence: 99%

Noninvasive skin imaging in esthetic medicine—Why do we need useful tools for evaluation of the esthetic procedures

Dopytalska

Sobolewski

Mikucka-Wituszyńska

et al. 2020

J of Cosmetic Dermatology

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Background: Despite the constant development of aesthetic medicine, there is still a lack of objective methods to assess the effectiveness of antiaging treatments and their impact on the skin. Histopathological examination of the skin section provides most of the key information about the condition of the skin, but it is an invasive procedure that requires a skin biopsy, which may be associated with the formation of a scar that is considered to be an aesthetic defect. Non-invasive imaging methods of the skin like dermoscopy, skin ultrasonography and reflectance confocal microscopy may be a useful solution. Aims and Methods: In this systematic review, we present the possible application of noninvasive skin imaging methods in esthetic medicine. The literature search was conducted via medical database (PubMed, Google Scholar). Results: The research suggests the use of dermoscopy during laser therapy, for the targeted treatment of vascular lesions and appropriate adjustment of laser parameters. Skin ultrasonography, especially high-frequency ultrasonography, has been widely used in aesthetic medicine-during and after volumetric treatments and in the assessment of the effects of anti-cellulite therapies, treatments that correct discolorations and improve skin quality. Publications also highlight the importance of reflexive confocal microscopy in the evaluation of the results of anti-aging treatments using the fractional laser, moisturizing preparations or micro puncturing combined with hyaluronic acid injections. Conclusion: Non-invasive skin imaging methods are useful tools for pre-and postoperative assessment in aesthetic medicine and their wide application may help to objectively assess the impact of anti-aging procedures on the skin.

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“…There are two main dermoscopic patterns of PWS: superficial (papillary) pattern characterized by dotted and globular vessels representing vertically oriented capillaries and deep (sub-papillary) pattern characterized by reticular and linear vessels representing horizontally oriented capillaries. A mixed pattern may be observed (Kwiek et al, 2019;Vazquez-Lopez, Coto-Segura, Fueyo-Casado, & Perez-Oliva, 2007). There is no consensus on the lowest effective fluence that should be used at the beginning of therapy (Shirakawa, Ozawa, Wakami, Ishii, & Harada, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Several factors affect the outcome of PDL treatment of PWS: skin phototype, localization, previous treatment, and depth and caliber of PWS vessels. Dermoscopy has been used in different clinical trials to visualize vessel characteristics and to predict the outcome of PDL treatment (Kwiek et al, ; Motley, Lanigan, & Katugampola, ; Procaccini, Argenziano, Staibano, Ferrara, & Monfrecola, ). There are two main dermoscopic patterns of PWS: superficial (papillary) pattern characterized by dotted and globular vessels representing vertically oriented capillaries and deep (sub‐papillary) pattern characterized by reticular and linear vessels representing horizontally oriented capillaries.…”

Section: Introductionmentioning

confidence: 99%

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

Latif

Abdel-Hameed

Salama

2019

Dermatologic Therapy

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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.

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Predictive value of dermoscopy for the treatment of port‐wine stains with large spot 532 nm laser

Cited by 24 publications

References 18 publications

Characterization of Laser‐Resistant Port Wine Stain Blood Vessels Using In Vivo Reflectance Confocal Microscopy

Characterization of Laser‐Resistant Port Wine Stain Blood Vessels Using In Vivo Reflectance Confocal Microscopy

Noninvasive skin imaging in esthetic medicine—Why do we need useful tools for evaluation of the esthetic procedures

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

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