| ObjectiveTo explore the clinical efficacy and adverse reactions of hemoporfin photodynamic therapy(HMME-PDT)in the treatment of port-wine stains(PWS),analyze the factors that affect the efficacy.And according to the results of the treatment of PWS in the extremities,explore the effect of heat-assisted on the curative effect.Part one:Clinical analysis of HMME-PDT in the treatment of PWSMethodsHMME-PDT is a new treatment for PWS in recent 2-3 years.68 patients with PWS who received HMME-PDT in the laser beauty center of Dermatology and Venereology Department of our hospital from July 2017 to December 2019 were included.All patients received 2-6 times of treatment,once every two to three months,until reaching the endpoint of curative effect.The main endpoint of curative effect was to achieve marked effect in the second course of treatment,and the secondary endpoint was to achieve cure.All patients were given skin allergy tests before treatment.Patients with negative skin tests were injected with hemoporfin(5 mg/kg)slowly and evenly by the intravenous pump.The infusion time was set at 20 minutes.After 10 minutes of infusion,they have exposed to 532 nm LED light with a power density of 80-95 m W/cm~2and irradiation for 20 minutes.The total treatment time was 30 minutes.During the treatment,cold spray and other equipment were used to relieve the pain.Immediately after the treatment,the patient went into the room without UV to rest,and cold compress with an ice bag.Before and after each treatment and during the follow-up period,all patients took digital pictures,and some patients took dermoscopic images for efficacy evaluation.SPSS 23.0 software was used to analyze the relationship between different factors and curative effect.ResultsFinally,a total of 68 patients with PWS were included,including 32 male PWS patients and 36 female PWS patients,with a male to female ratio of 1:1.12.The youngest was 2years old,the oldest was 44 years old,and the average age was 13.69 years old.The effective rate of 68 patients was 80.88%.During treatment,there were different degrees of itching,burning,and another discomfort.After treatment,mild to moderate edema could be seen,which could subside by itself.The medium and long-term adverse reactions were blister in 2 cases(2.94%),pigmentation in 6 cases(8.82%),and hypopigmentation in 3 cases(4.41%).There were no other serious adverse reactions.The curative effect is different between different patients.Fisher exact probability method and Spearman correlation test was used to analyze the influence of gender,age,location,type,area,treatment times,whether received treatment before and treatment interval on the curative effect.Results the highest effective rate was 87.1%(27/31)in2-10 years old group,and the lower effective rate was 72.22%(13/18)in>20 years old group.The response to HMME-PDT was different among the three age groups(P=0.014),and our analysis showed that the efficacy of HMME-PDT in the treatment of PWS in the 2-10 years old group was better than that in the above 11 years old group.In68 patients,51 cases of skin lesions located in the head,face and neck,after treatment,the effective rate was 88.24%(45/51).17 patients were located in the trunk and limbs,the effective rate was 58.82%(10/17).HMME-PDT was more effective than trunk and limbs in the treatment of head,face and neck PWS(P=0.009).The effective rate of bright red type was 90.0%(27/30),and the treatment effect was the best.The results showed that there was a negative correlation between the type of skin lesions and the curative effect.The curative effect of bright red type was better than that of purple-red type and thickened type(r_s=-0.400,P=0.01).The lesions of 68 patients with PWS were different in size.We divided them into<10cm~2,10-30cm~2and>30cm~2,which were called small,medium and large area respectively.The effective rate was 88%(22/25)in 25 patients with a small area,82.76%(24/29)in 29 patients with a medium area,and 64.29%(9/14)in 14 patients with a large area.There was a significant difference in the curative effect between patients with different sizes(P=0.045).But different gender,different times of treatment,whether received treatment before has nothing to do with the curative effect.According to the clinical experience analysis,if the treatment interval is more than half a year,the skin lesions are easy to progress.It is recommended to receive treatment every 2-3 months.There are various types of blood vessels under dermoscopy.Dermoscopic images can be used as a supplement to clinical images to judge the clinical efficacy,which is as effective as clinical images.Part two:The effect of heat assistance on the efficacy of HMME-PDT in the treatment of PWS of extremitiesMethodsThrough clinical studies,it was found that HMME-PDT was not good effective in the treatment of PWS in extremities.To further explore how to improve the efficacy of HMME-PDT in the treatment of PWS in extremities From January 2020 to December2020,8 patients with PWS of extremities were collected and divided into treatment groups and control groups.Before treatment,4 patients in the treatment group were covered with a heating pad,and the photosensitizer was infused half an hour later.The heating pad was removed 10 minutes after the infusion(when the light began to receive).The control group was not given thermal adjuvant treatment.After 2-3 times of treatment,the curative effect was evaluated by clinical pictures,and the influence of heat-assistant on the curative effect of PDT was analyzed.ResultsIn the experiment to explore the effect of heat assistance on the curative effect of HMME-PDT,3 cases in the treatment group were improved or above.The effective rate was 75%.In the control group,1 case showed improvement,3 cases still showed no effect after 2-3 times of treatment,the effective rate was 25%.Because the sample size is too small to do further analysis,more samples need to be included in the future.Conclusions1.HMME-PDT is safe and effective in the treatment of PWS with fewer adverse reactions.The total effective rate was 80.88%.Age,lesion location,lesion classification,and lesion area were the influencing factors of curative effect.Age<10 years old,lesion area<10cm~2,head,face and neck,bright red lesions had a better curative effect.Gender,times of treatment,and previous treatment had nothing to do with the efficacy.If the treatment interval is more than half a year,the skin lesions may develop further.Therefore,it is suggested that PWS patients should be treated early and on time to avoid over-treatment.2.Dermoscopy is a simple examination tool,which can be used to observe the changes of blood vessels as a reference to evaluate the curative effect.3.Thermal assistance can improve the efficacy of HMME-PDT in the treatment of PWS patients,but a larger sample is needed to verify. |
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