The Application Research Of Treatment Of Port Wine Stains With Fractionated Microneedle Radiofrequency

Part 1 A Retrospective analysis of 440 port wine stains patients treated with595 nm pulsed dye laserBackground:Port wine stains are a type of heterogeneous capillary malformation in superficial dermis.The incidence in the general population is 0.3%to 0.5%.The lesions of port wine stains present as pink to erythrmatous patches on the skin at birth.Without treatment,the patches typically darken with age and may eventually develop nodular thickening or associated pyogenic granuloma.With treatment at the early stage,later complications may be reduced in the PWS,which include cutaneous hypertrophy,disfigurement of the normal tissue,pyogenic granuloma,and psychosocial morbidity.The theory of laser treatment on PWS is to use selective photothermolysis of laser on the focal vessels.A variety of vascular selective lasers can be used on PWS and pulsed dye laser(PDL)has been considered as the gold standard for the treatment on PWS.However,as reported,only 10%~15%patients with PWS could be cured by PDL,and 20%–30%patients showed resistance on PDL.Objective:To summarized the efficacy of 595nm PDL in the treatment of PWS,and to analyse the efficacy differences of PDL in different groups of PWS patients.Methods:A retrospective analysis of 440 patients with PWS treated by 595nm PDL from January 2011 to December 2016.The 440 patients were classified as different groups according to the age,type of lesion,area of lesion and times of treatment.Based on the evaluation of dermatologist before and after the treatment,the therapeutic effects were judged as recovery,excellence,effectiveness,and invalid.Then we analysed the influence of the factors above mentioned and recorded the side effects and complications.Results:440 PWS patients treated with PDL were enrolled in this study,including171 men and 269 women,with ages from 0 to 60 years.For the age distribution,there were64 cases from 0 to 3 years,71 cases from 4 to 10 years,124 cases from 11 to 20 years,181cases above 20 years.For the lesion types,there were 201 cases(45.68%)with pink,169cases(38.4%)with purple and 70 cases(15.91%)with hypertrophic.For the lesion area,there were 155 cases(35.23%)with 6~20 cm~2 and 126 cases(28.64%)with 2~5 cm~2.These patients received from 1 to 21 times of treatment with a mean of 3.81 times.After treated with the PDL,70 patients(15.91%)showed recovery,149 patients(33.86%)showed excellence,148 patients(33.64%)showed utility and 73 patients(16.59%)showed invalids.The 595 nm PDL was safe for PWS patients and had satisfactory clinical effect and lower side effects.However,the rate of recovery was low,and a minority of patients showed ineffectiveness to PDL.The most commom side effects of PDL treatment on PWS were redness,swelling and purpura which would fade over of itself in 1~2 weeks.Of the 440 patients,45 patients had long-lasting adverse reactions,including 4 cases with atrophic scar(0.91%),14 cases with hypopigmentation(3.18%),and 27 cases with hyperpigmentation(6.14%).There were no severe adverse reactions such as ulcers and hypertrophic scars.Conclusion:The 595 nm PDL was safe for PWS patients and had satisfactory clinical effect.However,the rate of recovery was low,and a minority of patients showed ineffectiveness to PDL.Thus,novel laser systems and techniques for refractory PWS are underway in order to improve treatment outcomes of all patients.Part 2 A Research of Fractionated Microneedle Radiofrequency Acting on Chicken Combs--an Animal Model for Port Wine StainsBackground: Fractionated microneedle radiofrequency(FMRF)is a novel device which can precisely control the radiofrequency(RF)energy in the dermis and effectively avoid epidermal damage from heat through microneedle electrodes penetrating the epidermis.Radiofrequency technology has been used for tissue cutting,ablating,desiccating,coagulating,electrolyzing and dermal heating in dermatology for many years.According to the literatures,FMRF has the characteristics of potential anti-inflammatory and anti-angiogenesis which can be considered as a safe and effective method for post-inflammatory erythema.Therefore,in the present study,we investigated the mechanism of radiofrequency energy acting on the capillary through FMRF treating the port wine stains model cockscombs and analysing the histopathological changes of treated cockscombs.Objective: To investigate the effect of FMRF on PWS model cockscombs,and to explore the feasibility of PWS treated with FMRF.Methods: One side of cockscombs were treated with FMRF,and the untreated side of cockscombs served as the self control.The radiofrequency was delivered to cockscombs with microneedle in the depth of 1.5mm,on the radiofrequency pulse width of 1000,1500,and 2000 ms and at the energy levels of 0,10,16,and 20 W,respectively.The cockscombs samples of each group were obtained on the 14 th day and 28 th day after treated with FMRF.The reduced rate of cockscombs capillary and area percentage of collagen typeⅠ/Ⅲ were observed and calculated through HE staining and immunohistochemical staining.Results: The reduced rate of the cockscombs capillary in the treatment groups on the 14 th day were 52.33%±5.82%(10W/1000ms/1.5mm),57.33%±7.26%(10W/1500ms/1.5mm),62.67%±6.15%(10W/2000ms/1.5mm),56.00%±8.58%%(16W/1000ms/1.5mm),62.50%±6.03%(16W/1500ms/1.5mm),66.17%±6.91%(16W/2000ms/1.5mm),60.50%±6.16%(20W/1000ms/1.5mm),67.33%±5.96%(20W/1500ms/1.5mm),72.50%±8.87%(20W/2000ms/1.5mm),0.83%±2.99%(0W/1000ms/1.5mm),-2.83%±1.17%(0W/1500ms/1.5mm)and-2.00%±6.07%(0W/2000ms/1.5mm),respectively.The reduced rate of the capillary number in the groups with RF increased significantly compared with the groups without RF(all P<0.001).On the corresponding treatment,the reduced rate of capillary number on the 28 th day increased significantly compared with on the 14 th day(P=0.001).On the 28 th day,the area percentage of collagen typeⅠ/Ⅲ incerased significantly on the groups with the parameters of 16W/2000ms/1.5mm,20W/1000ms/1.5mm,20W/1500ms/1.5mm and 20W/2000ms/1.5mm compared with other groups.(P<0.001).Conclusion : FMRF might effectively reduce the capillary number of the cockscombs through damaging the capillary network.With suitable radiofrequency energy levels and pulse width,the ratio of collagen type I/III would remain stable in the recovered cockscombs.With excessive energy levels,the risk of cockscombs fibrosis would increase.Part 3 Clinical Applications of Fractionated Microneedle Radiofrequency in the Treatment of Intractable Port Wine StainsBackground: As a progress disease,PWS may present at birth as pinks or erythematous patches on the skin and/or mucosa.Without treatment,the patches gradually darken and thicken with age.Some may eventually develop into nodules or pyogenic granulomas.The process of progressive thickening in PWS is not due to hyperplasia or proliferative changes but related to continuous vascular ectasia in the dermis.The development of hypertrophy in PWS is a common factor that affects outcomes.Despite the continuous development in the laser technology and treatment,most of the lesions with thickening or nodules still have poor response to laser therapy,which brings great challenges to dermatologists.Objective: The aim of this study was to evaluate the efficacy and safety of the treatment using fractionated microneedle radiofrequency alone or combined with PDL in intractable PWS.Methods: 8 patients with intractable lesions participated in this study while 3 cases were excluded due to loss of contact.The other 5 patients were all older than 20 years with the lesion area of 35~147 cm2 and the type of purple or hypertrophic.The subjects voluntarily received the treatment of fractionated microneedle radiofrequency alone or combined with PDL.The treatment effect was evaluated with photographs and ultrasound examination before the first and after the last treatment by dermatologists.Adverse events were also registered.Results: After the treatment of fractionated microneedle radiofrequency alone or combined with PDL,all of the 5 patients improved obviously.Hypertrophy seemed to respond better than colour to the treatment.Therefore,the treatment of FMRF combined with PDL is recommended to improve the efficacy.The side effects included pain,erythema,edema,exudation,scab and furfuration.There was one patient with nerve injury.Conclusion:Fractionated microneedle radiofrequency can be used alone or combined with PDL to treat intractable port wine stains.