The Application Research Of Aminolevulinic Acid-Photodynamic Therapy Of Port Wine Stains

Background:Port wine stains are heterogeneous vascular malformations, withoutendothelial cell proliferation in histological. They are found in0.3–0.5%of newborns.PWS begin as thin macular lesions in infancy and early childhood and tend to thickenand nodule with age increased. PWS has be treated effectively with the pulsed dye laser(PDL) in past20years, and PDL was believed the gold standard in the treatment ofPWS. But only10～15%patients with PWS can be cleared by PDL, some patientsshown to be resistance to the treatment with PDL.Objectives: In order to explore more effective therapy, the study summarized thecurative effect and safety of the595nm pulsed dye laser in the treatment of port winestains, and analysis the characteristics in the patients with PWS resistance to595nmpulsed dye laser treatment.Methods: Clinical data of patients with PWS from August2006to August2011treated with595nm PDL were retrospectively analyzed, the evaluation was conductedby patients or their relatives and dermatologists who did not take part in the treatment,according to comparing photographs at baseline and3～6months after last treatment.The data were sorted according to the patients' age, skin type, site, area and type oflesion and so on. Total curative effect was judged according to recovery, excellence,utility, and invalids. The side effect and complications were recorded. In order toanalyze the influence due to the factors above mentioned, we did some necessarystatistical processing. We did further research about the resistant PWS to analyzed the possible reasons.Results:1285patients with PWS were treated by595nm PDL during the study time,including1036patients (males417,females619, ages from0to60years with meanages of11.87±12.72years) with completely case records, except for no detaildocumentation, or with≥2sites lesions in one patient. Fitzpatrick Ⅲ660, FitzpatrickⅣ376. Lesion locatedfacial surface862(83.20%), other site174(16.80%). Lesionarea1～5cm2accounted for35.91%,5～20cm2accounted for34.17%. Lesion typesinclude pink149(14.09%), scarlet719(69.40%), prunus88(8.49%)and hyperplasia83(7.80%).These patients had received1to14times of treatment with a mean of3.85±2.23times. After treatment with the PDL, there were147patients(14.19%) showrecovery,387patients(37.36%)show excellence,349patients(33.69%)show utilityand153patients(14.77%)show invalids.56patients reached platform after＞6treatment sessions, and become unresponsive to further treatments which is termed asrecalcitrant PWS. Therefore, the number of patients with resistant-PWS were153(invalid) add56, with20.17percent in all patients(153+56/1036). The cultivate effectsshow better when the lesion areas were smaller,or the ages were younger.The main complications were pain of the regional area (all had different degree pain),purple patch (91.89%) and edema (44.11%). Hyper-pigment and hypo-pigment were17.57%and11.10%respectively. There were38cases with atrophic scar (3.67%) and3cases with degenerated scar (0.29%), and ulcer was seen in3patients (0.29%).Conclusions:595nm pulsed Dye Laser is safe in treating PWS. There was satisfactoryclinical effect and lower side-effects, but complete recovery is lower, and some PWSpatients show resistance to PDL. Background:Photodynamic therapy (PDT) is used in the treatment of PWS by light,photosensitizer and oxygen interaction, PDT utilizes a photosensitizer and suitable lightor laser to generate reactive oxygen species and creates an opportunity for targeted cellor tissue destruction, caused the cell apoptosis or tissue lesion. PDT has been used totreat PWS by offer advantages for treatment of cutaneous vascular lesions, and avoiddestructing normal epidermal and dermal tissue. Topical ALA application, and thenirradiated by laser or light was paid close attention to now, which therapies include PDTand PDL. There are some documented about served the comb as PWS model, localALA application by system or local injection, and then measured high PpIX acuminatedin the local, it suggested local injection photosensitizer can be an administration form inthe treatment of PWS by PDT. Illuminated by this, the study was designed to explorethe mechanism of ALA topical application and then followed by595nm pulsed dyelaser irradiation for treatment of port wine stains model-comb.Objective: To explore the mechanism of ALA topical application and then followed by595nm pulsed dye laser irradiation for treatment of port wine stains model-comb.Methods: A total of twenty-one6-month—old male chicken were divided into3groupswith7in each group. The side of the untreated comb was served as the self control. Chicken in group A were left intact. In group B, ALA topical application for3hours,and then irradiated with595nm pulsed dye laser at one week interval in the right, theleft as self-control without irradiant. In group C, the combs received595nm pulsed dyelaser irradiation alone in the right, the left as self-control without irradiation. Thegeneral condition of chicken during experiment was observed. HE staining wasperformed to the tissues of the combs. On the14th day after the last treatment, and thedecrease rate of the number of capillary vessels was calculated. Besides, TUNELstaining was conducted to observe the condition of capillary endothelium apoptosis.Skin confocal microscopy was used to observe the blood changes after management;transmission electron microscopy was used to observe the capillary endothelium microschange.Results: No animal died after the study, the combs in group A, the control sides ofgroup B and C had no obvious changes in shape and color, but the experimental sides inthe B and C groups showed exudation, edema and dark crust. According to histologicalobservation, the self control sides of the combs in group A, B and C all had no obviouschanges. But in the treatment sides in the B and C groups, tissue fluid seepage, edema,inflammatory cell exudation, decreasing number of vessels, waning vascular caliber,thrombus, and partial capillary endothelium apoptosis were found. The decrease rate ofthe number of capillary vessels was as follows:61.16%±14.59%and48.53%±6.02%inthe control sides of group B and C. The apoptosis index in the control sides of group Band C was101.23±8.16and80.11±7.26respectively. There were significant differencesbetween self comparison as well as the comparison between group B and C.(P<0.01).Conclusion: ALA topical application can be absorbed by capillary endothelium throwskin, and lead more thrombus to the blood vessel when followed by595nm pulsed dyelaser irradiation than used595nm pulsed dye laser alone. Background:There are many methods in treatments of port wine stains, but effect islimited, and there is different degree side-effect or complications companied by therapy.Our prior a large sample retrospective analysis about595nm pulsed dye laser in thetreatment of PWS has proved595nm pulsed dye laser is safe in treating PWS. Therewas satisfactory clinical effect and lower side-effects, but complete recovery is lower,(＜15%) and some PWS patients show resistance to PDL (20～30%). The study usingcomb as PWS model, ALA topical application can be absorbed by capillaryendothelium throw skin, and lead more thrombus to the blood vessel when followed by595nm pulsed dye laser irradiation than used595nm pulsed dye laser alone. Based onselectivity photo thermal separation principle (PDL) and target destruction (PDT) in thevascular malformation, topical ALA administration followed by irradiation with a595nm PDL may be more effective in the treatment for PWS, compared with PDL alone.Objectives: The role of pulsed dye lasers (PDL) and photodynamic therapy in thetreatment of port wine stains (PWS) are not satisfactory in all patients. The purpose ofthis study was to evaluate the safety and efficacy of the method that topical applicationof ALA spreading followed by595nm PDL compared with595nm PDL alone intreatment of PWS. Methods: We did a prospective, randomized controlled trial in which305patients withPWS were enrolled. We assigned patients to receive PDL treatment (PDL group) orlocal ALA application and then irradiation with595nm PDL (ALA-PDL group),followed up3~6months after last treatment session, and evaluate the differences of thecurative effect and the adverse reaction between the two groups. The main outcomemeasures were assessed according to the proportion of the patients whose lesions werecompletely cleared or not significantly improved, adverse reactions including pigmentdisturbance, skin atrophy, ulceration, infection and so on. Questionnaires were used toinvestigate the patients' satisfactory degree. The data obtained are computed andanalyzed via SPSS Version17.0.Results: All208patients with PWS completed the study, which includes101patientswho were in PDL group and107patients who were in ALA-PDL group. The number ofpatients whose lesions showed complete clearance or minimum residual signs at0.5year follow up was significantly different in the PDL group and ALA-PDL group(13,12.87%, vs23,21.50%). Lesions showed no obvious change was significantlydifferent in the PDL group and ALA-PDL group (16,15.84%, vs9,8.41%). However,ALA-PDL treated patients were more likely to have skin atrophy (18,16.82%, vs4,3.96%) and hypo pigmentation (25,23.36%, vs11,10.89%). The questionnaire abouttreatment was significantly different between the two groups, the ALA-PDL group issignificantly higher than the PDL group (76,71.03%, vs53,52.48%).The effect ofhyperplastic PWS in ALA-PDL group is better than that in PDL group.Conclusion: Topical ALA administration followed by irradiation with a595nm PDL ismore effective in the treatment for PWS, compared with PDL alone. Theimmediate-reaction is similar with PDL alone, but it is more likely to cause dermatrophy and pigment changes. It is worth attention in clinical treatment. Background:More than20%port wine stains resistance to the pulsed dye laser, eventhough this method was considered as the first line treatment. Lymph fluid reflow blockand soft tissue hypertrophy were often come cross in the lesions of PWS as ageincreases. Complete clearance of any PWS is difficult to achieve even with earlyintervention, and most laser-treated PWS continue to darken if left untreated.Furthermore, many PWS that respond well initially to PDL treatment may reach aresponse plateau, becoming unresponsive to further PDL treatments, a phenomenontermed "treatment resistance". While there a likely multiple reasons for treatmentresistance and incomplete clearance with PDL. Photodynamic therapy (PDT) has beenclinically used in the treatment of PWS, but photosensitzer was often used by injectionform vein or local. Local injection of ALA in the PWS lesions, and then irradiated by595nm PDL, was documented to be useful, therefore, ALA local application and thenirradiated by595nm PDL may be useful in treatment of PWS.Objective: The purpose of this study was to evaluate the safety and efficacy of a novelalternative method in treatment of recalcitrant PWS, namely topical application of ALAfollowed by595nm PDL irradiation.Methods: Eighty-seven patients (Forty-six females and forty-one males, skin phototypes Fitzpatrick Ⅲ59patients, and Ⅳ28patients) with recalcitrant PWS were enrolled in the study. Their PWS showed incomplete clearance after8to10timestreatment of PDL. They were subjected to successive treatments using20%ALA astopical spreading and then irradiated with595nm PDL at4to6-week intervals. Clinicalimprovement of lesion was evaluated after≥3treatment sessions by comparingphotographs at baseline and2months after last treatment.Results: The use of topical ALA spreading and then irradiation with595nm PDLimproved PWS in52out of87patients that were previously recalcitrant to PDLtreatment alone. Side effects were limited to transient erythema, edema, vesicleformation, and mild purpura, and subsequent atrophy scarring were seen in16patients,undesirable pigment changes were seen in23patients.Conclusion: Topical ALA spreading followed by irradiation with595nm PDL is aneffective and safe treatment for PWS recalcitrant to PDL therapy. It was thought highlyof unwanted scar and pigment in the treatment.