Study Of The Role Of Reflectance Confocal Microscopy In The Evaluation Of Efficacy And Prognisis Of Treating Port Wine Stains With Pulsed Dye Laser

Part I Evaluation of595-nm pulsed dye laser with different pulse width in the treatment of port-wine stainsObjective:To observe the efficacy and safety of595nm PDL with different pulse width in Chinese PWS patients. Methods:44PWSs lesions of different Chinese patients were divided into four groups and was treated with four different pulse width (1.5、3、6、10ms) of595nm PDL separately.11patients(male6,female5, Skin type Ⅲ-Ⅳ, age15-50, average age24.82±9.82)from our outpatient department were enrolled in this study. The laser treatment was performed with an energy density of9-12J/cm2,using a spot size of7mm. The PDL treatment was repeated3-5times at8-week intervals. Photographs were taken before the treatment and2month after the last treatment, and then evaluated and scored by one independent experienced physicians(score1,<25%;score2,26%-50%;score3,51%-75%;score4,76%-100%). Scori ng was depended on the regression of the lesion, decreasing of the area and changing of the colour before and after the treatment. In addition, each assessment also included adverse effects such as hyperpigmentation, hypopigmentation and scars.Results:All PWSs patients with44lesions accepted3-5times laser treatment. The mean total improvement rate and significant improvement rate at2month-follow-up were47.73%and27.28%respectively. The total improvement rate of1.5ms、3ms、6ms、10ms pulse width was63.64%、63.64%、36.37%、27.27%respectively. The significant improvement rate was45.46%、27.27%、18.18%、18.18%respectively. The mean score of1.5ms group was3.00, higher than other group((2.82、2.36、2.18respectively, with descending order). The mean score for all lesions was2.59. With regard to the color of PWS, the purple hue was less sensitive than the pink or red hue. In all significant improvement and moderate improvement areas, pink and red lesions consist of57.14%%, higher than purple lesions. Adverse effects:Purpura was observed in nearly all the patients. Hyperpigmentation (11.36-15.91%) and hypopigmentation (2.27-6.82%) was seen mainly in1.5ms and3ms groups, which was transient and resolved within three months. There was no case of scar formation. Conclusion:PDL can treat Chinese PWS patients effectively with high safety and minimal side effects.1.5ms pulse width group surpassed other pulse width groups in its efficacy. Part Ⅱ The application of Reflectance confocal microscopy (RCM) in clinical assessment and prognostic judgement in PWSObjective:To compare the difference of superficial vessels(diameters, densities) between PWS patients and normal volunteers with RCM. Methods:10patiens with faciocervical PWS and10normal volunteers(8males,12females, skin type Ⅲ-Ⅳ, age13-36year-old, average18.30±5.66year old) were enrolled in the study. RCM examination was performed on a randomly selected PWS area of the patients. The same examination was also done on the same anatomical area of a normal volunteer. The assessment was done only once. Results:The mean vessel diameter is larger in PWS patients (71.70±27.11μm) than in normal volunteers (19.00±9.74μm)(P<0.01). There is also significant difference in mean vessel density between two groups(15.00±2.87μm in PWS patients vs8.50±3.21μm in normal volunteers)(P<0.01). Vessels are more dilated in lesions of purple color. The diameter of vessels in the face(80.43±25.47μm) are larger than those in the neck(51.33±21.73μm) in PWS patients. Conclusion:RCM can characterize abnormal and normal vessels, which may help to judge the end point and prognosis in the laser treatment of PWS objectively. Part Ⅲ Clinical application of RCM in the treatment and prognosis of PWSObjective:To judge the prognose and evaluate the correlation of clinical efficacy and pulse width parameter of595nm PDL with different pulse width in Chinese PWS patients by RCM examination of diameters and density of vessels beneath the skin. Methods:44PWSs lesions of different Chinese patients were divided into four groups and was treated with four different pulse width (1.5、3、6、10ms) of595nm PDL separately.11patients(6males,5females)from our outpatient department were enrolled in this study. Photographs were taken and RCM examination(vessel diameters,mean vessel diameters, and vessel density) were performed every time before the treatment and2month after the last treatment.The results were evaluated and scored by one independent experienced physicians. Adverse effects such as hyperpigmentation, hypopigmentation and scars were also recorded. Results:1.RCM scanning of100and150μm depth layer showed significant decrease of vessel diameter and density before and after treatment in all pulse width group(P<0.05).2. There was no significant difference between different pulse width groups in reducing vessel diameter at100μm depth But1.5ms groups surpassed others at150μm depth (P<0.05). There was no significant difference between different pulse width groups in reducing vessel densities.(P>0.05)3. The purple lesions was less sensitive to the treatment than the pink or red ones. RCM examination revealed purple lesions have larger vessels. The5largest mean vessel diameters at100μm and150μm layers are all purple PWS patients, consisting5/7of all purple lesions. The vessels at150μm layer are larger than those at100μm layers.4. Purpura was observed in nearly all the patients,and was mostly obvious in1.5ms group. Purpura in10ms groups was comparatively mild, which can be tartive. There is positive correlation with the change of vessels diameters and purpura reaction in150μm layers.The vessel diameter change was most obviously in1.5ms group(P<0.05)5. After3times PDL treatment, among4treatment groups, at100μm and150μm RCM layers, the reduction of vessel diameter was most significant in1.5ms group (49.69%and66.06%separately); In these two layers, the reduction of vessel diameters of all pulse width groups is among50-69%, but mean density of vessel is close to10, similar to that of normal skin(8.50±3.21) Conclusion:RCM can detect the change of vessel density and vessel mean diameters in PWS patients before and after treatment in real-time and non-invasive mode. RCM result revealed that it was mainly the reduction of vessel diameter that decided the effect of the treatment. Before the treatment, RCM could help to judge the mean vessel diameter, vessel density of different layers, helping to predict the vessels changes and treatment effect. The vessels in deeper layer maybe more meaningful to the prognosis of treatment effect. So, the result of RCM may help to choose the suitable lesions and optimal treatment parameters, and help to judge prognosis and terminal time of the treatment.