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      Treatment of port wine stains with pulsed dye laser: a retrospective study of 848 cases in Shandong Province, People’s Republic of China

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          Abstract

          Background

          Currently, 595 nm pulsed dye laser (PDL) therapy is offered as one of the effective treatments of port wine stains (PWSs). However, the efficacy of PDL differs in different populations.

          Objective

          The purpose of the study was to investigate the efficacy, and related factors, of 595 nm PDL in the treatment of PWSs in Chinese patients with skin type III to IV.

          Methods

          A total of 848 cases that were treated with PDL were enrolled and analyzed in this study. An independent dermatologist evaluated these lesions according to the before and after photographs.

          Results

          The response rate (RR) of all the 848 PWS patients was 69.9%, within which the cure rate was 6.3%. The patients aged ≤1 year had the highest RR (93.9%), whereas those treated after age 50 reacted the worst (RR =25%). We analyzed the anatomical distribution of the lesion and found that the temporal region had the highest lesion clearance (RR =75.3%), while the extremities had the lowest clearance (RR =44.5%). Compared with the patients whose lesion size was larger than 80 cm 2, the patients with small lesion size, of 0–20 cm 2, had better clinical effect (RR =73.8% vs 53.2%). The reactions of the patients with hyperplastic lesion were worse than those with red patches (RR =36.4% vs 71.7%). As well, increasing treatment numbers could achieve higher clearance rates ( P=0.005).

          Conclusion

          The PDL had a relatively high RR but a low clearance rate in Chinese patients with PWS, although the earlier the intervention, the better was the efficacy. The response of PDL was, not only related to the anatomical area, but also, to the lesion size, type of lesion (ie, the presence of existing hyperplastic lesions), and the number of treatment, all of which are essential for the evaluation of therapeutic effect and acquisition of patients consent before treatment.

          Most cited references26

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          Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation.

          Suitably brief pulses of selectively absorbed optical radiation can cause selective damage to pigmented structures, cells, and organelles in vivo. Precise aiming is unnecessary in this unique form of radiation injury because inherent optical and thermal properties provide target selectivity. A simple, predictive model is presented. Selective damage to cutaneous microvessels and to melanosomes within melanocytes is shown after 577-nanometer (3 x 10(-7) second) and 351-nanometer (2 x 10(-8) second) pulses, respectively. Hemodynamic, histological, and ultrastructural responses are discussed.
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            An overview of clinical and experimental treatment modalities for port wine stains.

            Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
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              Efficacy of early treatment of facial port wine stains in newborns: a review of 49 cases.

              Port wine stains (PWS) affect 0.3-0.5% of both sexes of newborns, usually occurring on the face. To document safety and effectiveness of cryogen spray cooled, pulsed-dye laser at higher fluences than previously used to lighten facial PWS in infants or =20%. Location (V1, V2, V3, eye, and/or scalp), treated surface area, treatment number, and fluence predicted clearance. Average clearance for sole involvement of V1 was highest (at 93.8%), followed by V2 (at 91.1%), V3 (at 84.3%), V1/V2 (at 83.7%), V1/V2/V3 (at 81.0%), periocular (at 88.6%), and scalp (at 89.9%). All patients tolerated the higher treatment fluences without atrophy or scarring. Frequent, high energy pulsed-dye laser treatments are safe and highly effective in improving facial PWS in infants < or =6 months of age. Patients with PWS should be referred for pulsed-dye laser treatment during early infancy.
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                Author and article information

                Journal
                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                Drug Design, Development and Therapy
                Dove Medical Press
                1177-8881
                2014
                12 December 2014
                : 8
                : 2531-2538
                Affiliations
                [1 ]Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China
                [2 ]Shandong Provincial Key Lab for Dermatovenereology, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China
                [3 ]School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China
                [4 ]Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, People’s Republic of China
                [5 ]Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, People’s Republic of China
                Author notes
                Correspondence: Huaxu Liu, Shandong Provincial Institute of Dermatology and Venereology, No 27397 Jingshi Road, Jinan, Shandong 250022, People’s Republic of China, Tel +86 531 8729 8873, Fax +86 531 8798 4734, Email liueternal@ 123456163.com
                Furen Zhang, Shandong Provincial Institute of Dermatology and Venereology, No 27397 Jingshi Road, Jinan, Shandong 250022, People’s Republic of China, Tel +86 531 8729 8801, Fax +86 531 8798 4734, Email zhangfuren@ 123456hotmail.com
                Article
                dddt-8-2531
                10.2147/DDDT.S71710
                4271787
                25548515
                7e1efa1e-20b5-482c-97ad-0a5b5c4e3d62
                © 2014 Shi et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Pharmacology & Pharmaceutical medicine
                capillary malformation,laser treatment,curative effect,chinese patient

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