Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)—A randomized controlled trial

Greveling, Karin; Prens, Errol P.; Doorn, Martijn B. van

doi:10.1002/lsm.22548

Cited by 36 publications

(58 citation statements)

References 37 publications

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“…11,[52][53][54][55] In a phase 2, randomized, double-blind, placebo-controlled clinical trial by Marqués et al, 52 23 patients tested topical sirolimus (1%) plus pulsed dye laser; the results suggested that topical sirolimus with pulsed dye laser was more effective than placebo or sirolimus alone or pulsed dye laser alone for the treatment of portwine stains in patients with Sturge-Weber syndrome. Greveling et al 11 published a randomized controlled trial of 14 patients comparing pulsed dye laser, pulsed dye laser plus sirolimus, pulsed dye laser plus erbium:yttriumaluminium-garnet laser plus sirolimus, and sirolimus monotherapy. The highest percentage skin clearance was achieved with pulsed dye laser alone, but there were no statistically significant differences between treatments.…”

Section: Vascular Malformationsmentioning

confidence: 99%

Efficacy and safety of sirolimus in the treatment of vascular anomalies: A systematic review

Freixo

Ferreira

Martins

et al. 2020

Journal of Vascular Surgery

142

115

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Objective: The management of vascular anomalies is complex and requires a multidisciplinary team with a combination of medical, surgical, and intervention treatments. Medical treatment is limited and has conflicting results. Off-label use of mammalian target of rapamycin inhibitors shows promising results. The objective of this study was to systematically evaluate the literature published about the efficacy and safety of sirolimus in the treatment of vascular anomalies. Methods: A systematic review of the published literature was conducted using the PubMed database and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: There were 73 articles included: 2 randomized controlled studies, 2 nonrandomized prospective studies, and 69 retrospective case reports and case series. In total, 373 patients were included. Sirolimus was administered topically to 56 patients and orally to 317 patients. Sirolimus was highly effective in the treatment of vascular tumors associated with Kasabach-Merritt phenomenon (95.5% of the patients clinically improved and 93% had normalization of coagulopathy), venous malformations (size reduction was observed in 88.9% of patients), and lymphatic malformations (clinical improvement in 94.9% of patients). Topical sirolimus results were conflicting. Arteriovenous malformations were not improved by sirolimus. Conclusions: Low-level evidence suggests that sirolimus can improve the prognosis of vascular anomalies, most notably vascular tumors associated with life-threatening coagulopathy and venous and lymphatic malformations. Further research is needed to establish the benefits of sirolimus in the management of vascular anomalies.

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Section: Vascular Malformationsmentioning

confidence: 99%

Efficacy and safety of sirolimus in the treatment of vascular anomalies: A systematic review

Freixo

Ferreira

Martins

et al. 2020

Journal of Vascular Surgery

142

115

View full text Add to dashboard Cite

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“…The use of a different type of DDS did not yield similar effect as the Tixel in our report. Greveling et al compared PDL‐only treatment to PDL + rapamycin, PDL + Erbium YAG laser ablation without thermal of the stratum corneum + rapamycin, and rapamycin monotherapy, and reported that the highest percentage clearance was achieved with PDL‐only treatment, but there were no statistically significant differences between treatments (Greveling, Prens, & van Doorn, ).…”

Section: Discussionmentioning

confidence: 99%

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

Artzi

Mehrabi

Heyman

et al. 2019

Dermatologic Therapy

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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

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“…julio -diciembre 2020 Gac Med Bol 2020; 43(2): podría prevenir la revascularización después del tratamiento con PDL; sin embargo Greveling y col. recientemente en un ensayo aleatorio demostraron que la aplicación tópica de la solución disponible en el mercado (Rapamune ® 0,1%) como un adyuvante al tratamiento PDL no parece mejorar el blanqueamiento de la lesión en el SSW, la Rapamicina oral podría tener resultados más prometedores, y se recomienda mayores investigaciones respecto a eficacia, efectos adversos y costo-efectividad 28 .…”

Section: G M Bunclassified

“…La Oxcarbazepina se asoció con menos efectos secundarios informados que otros antiepilépticos, por lo que puede ser preferible y se recomienda comenzar el tratamiento con Oxcarbazepina a menos que estén presentes características de crisis generalizadas 29 . El Topiramato a pesar de estar relacionado con desencadenar glaucoma agudo bilateral de ángulo cerrado empeorando el pronóstico en ciertos casos, no se asoció con signos relacionados al glaucoma en un análisis limitado de pacientes y los efectos secundarios informados del Valproato coincidieron con sus efectos conocidos, por lo que estos medicamentos podrían ser alternativas seguras para tratar la migraña y la epilepsia concomitantes, además de los triptanes y la Lamotrigina que también se han utilizado para este fin 4,28 . El ácido acetilsalicílico en dosis bajas (3 a 5 mg/kg/día) puede disminuir la frecuencia y la gravedad de los crisis epilépticas y de los episodios stroke-like 30 .…”

Section: G M Bunclassified

Síndrome de Sturge-Weber: revisión de la literatura

Sanz-Arrazola¹,

Antezana-Llaveta²

2020

GMB

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El síndrome de Sturge-Weber es un trastorno neurocutáneo, congénito, esporádico e infrecuente que afecta aproximadamente a 1 de cada 20 000 a 50 0000 nacidos vivos y que se relaciona con una mutación genética activadora somática en GNAQ. Clínicamente se caracteriza por la presencia de una mácula en vino de Oporto en la piel de territorio trigeminal, angiomatosis leptomeníngea y glaucoma. Puede asociarse a diferentes manifestaciones clínicas, de las cuales las crisis epilépticas representan la manifestación neurológica más frecuente que se asocia a un deterioro cognitivo importante en estos pacientes. En el presente artículo se realiza una revisión descriptiva de la literatura sobre los aspectos etiológicos, fisiopatológicos, de clasificación, clínicos, diagnósticos y del tratamiento del síndrome de Sturge-Weber.

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Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)—A randomized controlled trial

Abstract: Topical application of the commercially available solution of rapamycin (Rapamune 0.1%) as an adjuvant to PDL treatment does not appear to improve PWS blanching. Lasers Surg. Med. 49:104-109, 2017. © 2016 Wiley Periodicals, Inc.

Cited by 36 publications

References 37 publications

Efficacy and safety of sirolimus in the treatment of vascular anomalies: A systematic review

Efficacy and safety of sirolimus in the treatment of vascular anomalies: A systematic review

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

Síndrome de Sturge-Weber: revisión de la literatura

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