Treatment of port wine stain with Tixel ‐induced rapamycin delivery following pulsed dye laser application

Abstract

Although pulsed dye laser (PDL) is considered the gold standard treatment for port wine stains (PWS), post PDL revascularization is one of the main causes of incomplete regression and recurrence. Recently, topical sirolimus have been shown to improve treatment outcome probably through minimizing post-laser revascularization. We sought to evaluate the added value of the Tixel drug delivery system (DDS) to the PDL and topical rapamycin treatment for PWS. This case series includes three teenager patients with previously treated PWS with PDL. Upon enrollment, every stain was divided into A and B halves for treatment assignments to the following regimens: (A) PDL + DDS + rapamycin; (B) PDL + rapamycin. Subjects were instructed to apply rapamycin topically over the PWS twice daily for the entire treatment period.Assessment of the treatment and adverse reactions as well as photographs was performed at baseline and before every PDL treatment. There were clinically significant differences in blanching responses favoring PWS receiving PDL + DDS + rapamycin as compared to PDL + rapamycin alone. Transient hyperpigmentation was noted in one patient. Two patients developed mild transient irritation and dermatitis following the treatment on both halves. The use of drug delivery system combined with topical rapamycin has no remarkable adverse effects, improves the results of PDL treatment for port wine stains, and can reduce the total number of required PDL sessions. K E Y W O R D Sdrug delivery, port wine stain, pulsed dye laser, rapamycin, Tixel

Treatment of periorbital wrinkles using thermo‐mechanical fractional injury therapy versus fractional non‐ablative 1565 nm laser: A comparative prospective, randomized, double‐arm, controlled study

“…It has been previously shown that pulse durations around 6 milliseconds are used for drug delivery and those greater than 10 milliseconds are used for rejuvenation; common settings for rejuvenation are 12-14 milliseconds. 11,25,26 As the periorbital region is a sensitive area, coordinating treatment at two centers in different countries with diverse populations warranted more conservative treatment parameters. The depth was chosen based on the depth of the periorbital skin to the reach the papillary dermis ~300 µm (Figure 1).…”

“…In this study, we chose a more conservative approach with a pulse duration of 10 milliseconds and 500 µm protrusion. It has been previously shown that pulse durations around 6 milliseconds are used for drug delivery and those greater than 10 milliseconds are used for rejuvenation; common settings for rejuvenation are 12–14 milliseconds 11,25,26 …”

Evaluation of Device-Based Cutaneous Channels Using Optical Coherence Tomography: Impact for Topical Drug Delivery

“…Recently, there has been a growing sentiment that microneedling may be inferior to lasers and other energy-based modalities for device-assisted drug delivery. Thermomechanical injury has already been used to deliver botulinum toxin to mediate rosacea and Hailey-Hailey disease, 26,27 triamcinolone and 5-fluorouracil to reduce scar size, 28,29 rapamycin for enhanced pulsed dye laser treatment of port-wine stains, 30 and beta blockers for infantile hemangiomas. 31 Depending on the selected treatment parameters, the fractional thermomechanical device can allow for ablative or nonablative histologic effects because of heat transfer from short contact of the 400°C-heated pyramidal tip, 11 which can attain similar ablative temperatures to the CO2 laser.…”

Evaluating the efficacy and safety of topical sirolimus 0.2% cream as adjuvant therapy with pulsed dye laser for the treatment of port wine stain: A randomized, double‐blind, placebo‐controlled trial

“…It has been shown that hypoxia can result in the activation of two important and potent vascular proliferation patterns, including HIF‐1a and VEGF. Thus, it could be speculated that preventing this hypoxia‐induced revascularization may result in a better outcome of laser treatment 21 . It has been well‐known that mTOR signaling is a crucial pathway in the cellular response to hypoxia by HIF‐1α 10 .…”