Comparison Study Of Clinical Effects Of Pulsed Dye Laser And LED Photodynamic Therapy For Treatment Of Port Wine Stains(PWS)

Part One:Research BackgroundPort wine stains(PWS),commonly known as "red birthmark",is a congenital skin shallow capillary malformation.Histopathology showed the superficial dermis of dilated capillaries,there is no proliferation of endothelial cells.The incidence of newborns was 0.3%?0.5%,there is no significant gender differences and they are presented as abnormal skin erythema at birth,trauma or infection can also lead to acquired PWS occasionally.95%occur in the face and neck areas,trigeminal nerve distribution area is the most common site.Its mechanism is not clear and the hypothesis is that it is related to capillaries nerve abnormalities of the lesions region.The latest study,the foreign scholars confirmed cells gene mutations of GNAQ found in congenital PWS lesions.Port wine stains do not subside on their own,the early lesions is flat pink,along with the age growth gradually become red or purple color,and thickening of organization,can eventually form a thick nodular hyperplasia which can easily affect patient's healthy psychological development.Some PWS are part of a variety of serious syndrome,such as Sturge-Webers syndrome,KT syndrome etc.Today,everyone is emphasizing self-perfection and with the pursuit of quality of life,more and more patients and their parents are desperately seeking a safe and effective treatment.Currently,the proportion of such patients is up to 20%of laser clinic patients.The complex vascular lesions brings some difficulties of clinical treatment and therapy parameters selection.PWS conventional treatment methods include isotopes,frozen in liquid nitrogen,electrocautery,chemical peel,rays,surgery skin graft,low-power continuous laser treatment etc,which are non-selective with poor efficacy and easy to produce scars,pigmentation and other capacitive complications.It is difficult to be accepted by patients.With the development of laser medical technology,Professor Andersen proposed the theory of selective photothermolysis and the birth of pulsed dye laser(PDL)therapy in 1983.Its efficacy and safety have improved significantly and become the gold standard of Treatment of port wine stains.PDL(585nm or 595nm)can selectively interact with the hemoglobins within the abnormal vascular network and also with better penetration,regulation of pulse parameters help to achieve higher hemoglobin selective thermal coagulation,which induce coagulative necrosis,vascular embolism and to achieve the purpose of treatment.But for Asians,PDL cure rate is still less than 20%,and only a part of PWS is effective,there is a big difference in the texture of the skin after multiple treatment.Purpura phenomenon is obvious and easy to form a "spotted like change" after treatment,and the treatment of deep lesions may lead to scars.Currently,595nm PDL with dynamic refrigerant spray cooling system is lead to a less pigment changes and complications of scars.There is a part of the lesion with recurrence and deeper color after treatment,and laser combined with anti-angiogenesis inhibitor for treatment of port wine stains unfortunately only is a tentative study which may improve the therapeutic effect and reduce recurrence rate.Pulsed dye laser therapy is an important method for the treatment of port wine stains,there are still some patients are completely ineffective,called "Resistance PWS".Smaller diameter vascular(blood vessel diameter less than 20?m)is not lead to a complete light-coagulation action,therefore,patients with small diameter vessels may be less effective.However,it is difficult to be confirmed by PWS clinical apparence.The traditional pulsed dye laser works with complications and limited efficacy to Asians,we need a targeted and more selective treatment.A lot of works show that photodynamic therapy is a safe and effective alternative therapy for PWS.The early 1990s,the PLA General Hospital,Professor Gu Ying,etc.used photodynamic therapy for the treatment of port wine stains for the first time,and achieved good clinical efficacy,especially to large-area,thickening lesions with more advantages.Photodynamic therapy is highly selective,involving the regulation of administration and illumination,producing oxidative damage in diseased tissue mediated by the photosensitizer and cause apoptosis,necrosis and vascular injury.Because of its dual selectivity(ie,photosensitizers's selective absorption and the laser's penetration depth),vascular targeting make it superior to other therapies.With the in-depth study of new photosensitizers and light source,its efficacy and safety have improved significantly.Currently,PWS photodynamic therapy commonly used laser as light source(coherent light source),but less efficient,and Gauss phenomenon lead to a low safety threshold,high equipment cost,complicated operation and other factors limiting its clinical application and promotion.To further reduce complications and improve the efficiency of treatment,non-coherent light source(LED)causes a concern.LED light source(Light-emitting diode)is a new light source for photodynamic therapy,laser treatment regulatory by active non-thermal effects and dimming effect of low energy,also known as cold light.Diodes optimization technology has greatly improved the output intensity of the LED,so that the power can reach the same level of PDT.In clinical PDT teratments,LED light source has also been successfully used to treat skin diseases,oral diseases and rheumatoid arthritis etc,confirmed that the LED has great advantages in reliability,stability,and cost.Currently,LED clinical studies of photodynamic therapy of PWS is rarely reported.Currently,two main methods for the treatment of port wine stains,PDT and PDL,which has more efficacy advantage will still need to make effective clinical comparative studies.This will guide clinicians to choose a better treatment option.Clinical treatments have showed that different lesions of PWS have different sensitivities by treat with PDL or PDT,a part of PWS treat with PDL do not need to process complex PDT.While some insensitive PWS to PDL,there are no significant therapeutic effect and easy lead to complications.It is difficult to be confirmed by the clinically apparence,treatment by test a small area for reference only and the local lesion can not be fully representative of the whole lesion.Doctors mostly choose the treatment on their own terms,technology and experience,which lacks objective evidence to some degree and impact the cure rate.Therefore,it is necessary to conduct a scientific comparison of two treatments which will help to choose the best treatment options for different types of lesions and provide an objective basis.United States Beckman Laser Medical Center doctor Kelly has made preliminary self-controlled clinical trials of PWS.Professor Yuan Kaihua has made own clinical comparative study of 532-PDT and PDL,and treatment study of PDL compared with copper vapor-PDT has made as well.Early studies have shown that photodynamic therapy treatment effect of port wine stains is not inferior to or better than the pulsed dye laser in fade rate and incidence of adverse reactions.The new LED light source of photodynamic therapy need to compare with PDL.This paper analyzes and compares the efficacy of LED-PDT and PDL by prospective self-controlled clinical trials.Curative effect is assessed by an objective detection,and which will provide the basis for selection of optimized clinical treatment options.Part Two:Research Objectives1,Study the safety and efficacy of the LED light source used in photodynamic therapy for the treatment of port wine stains.2,Compare efficacy and safety of the LED photodynamic therapy and KTP laser photodynamic therapy for treatment of port wine stains.3,Compare and analysis efficacy and safety of the LED photodynamic therapy and pulsed dye laser for treatment of port wine stains,and provide reliable evidence for a best clinical treatment options.Part Three:Research MethodsChapter1 Research for application of the LED in the photodynamic therapy of the Port-Wine Stains(PWS)66 cases patients from the clinic of our department with the PWS,including 29 cases of red type and 37 cases of purple type,all treated with the LED with a power density of 80-100mW/cm2,irradiation time of 20-30min/spot.The photosensitizer was hematoporphyrin monomethyl ether,a dose of 5mg/kg.3-month follow-up of the pre-and post-treatment efficacy will be evaluated.Chapter 2 Comparison study of clinical effects of LED and KTP laser for photodynamic therapy of port wine stains(PWS)A total of 129 adult PWS patients were randomly divided into two groups:KTP laser treatment(N = 65)and LED treatment(N = 64).Patients were irradiated by either KTP laser or LED after the administration of photosensitizer HMME.They were followed up for three months and the efficacy were evaluated.Chapter 3 Comparison study of clinical effects of pulsed dye laser and LED photodynamic therapy for treatment of port wine stains(PWS)16 port wine stains participants,the focal points and four area:A:LED photodynamic therapy;B:pulsed dye laser area;C:the contralateral normal skin area;D:blank control area;Area A,B and D are the same anatomical location of lesions.Area A treat with HMME-LED photodynamic therapy,the photosensitizer was a dose of 5mg/kg;Area B treat with pulsed dye laser.16 participants,respectively before and after treatment for 3 months follow-up doctor chromaticity values and visual assessment.Part Four:Research ResultsChapterl Research for application of the LED in the photodynamic therapy of the Port-Wine Stains(PWS)After the first treatment,the total effective rate of the 66 patients was 60.6%.Among of those cases,the total effective of the red type was reached at 62.1%(18 cases),and 59.5%(22 cases)for the purple type,while no statistically significant difference(?2 = 0.046,P>0.500)was showed between the two groups.For the complication of the LED,Postoperative skin pigmentation,photosensitivity reactions,non-specific thermal injury were 12.1%,and 3.0%of the scarring formation.Chapter 2 Comparison study of clinical effects of LED and KTP laser for photodynamic therapy of port wine stains(PWS)The total effective rate of KTP group was 58.46%(38 cases)and that of LED group 62.50%(40 cases).There was no significant difference between the two groups(?2 = 0.220,P>0.500).Adverse reactions of KTP group was 36.92%(24 cases)and that of LED group only 15.63%(10 cases).There was significant difference between the two treatments(?2=7.536,P<0.010),with a different constituent ratio of adverse reactions.Chapter 3 Comparison study of clinical effects of pulsed dye laser and LED photodynamic therapy for treatment of port wine stains(PWS)In 16 patients,in type red port wine stains,in pulsed dye laser treatment area,3 months after the fading rate of 42.75%plus or minus 9.09%,LED photodynamic therapy treatment of 3 months after the fading rate of 43.24%plus or minus 10.61%,the curative effect of two kinds of therapy has no statistical difference;Type for the purple port wine stains,in pulsed dye laser treatment area,3 months after the fading rate of 29.76%plus or minus 6.84%,LED photodynamic therapy treatment of 3 months after the fading rate of 46.01%plus or minus 9.97%,results suggested there were statistical differences between two treatments,the curative effect of LED photodynamic therapy is superior to the effect of pulsed dye laser.Part Five:Research ConclusionKTP laser and the new LED light source for photodynamic therapy treatment of port wine stains can effectively eliminate the lesion color.But the new LED light source has fewer complications than the KTP laser,more secure,lower cost,and better effect.For treatment of red type,pulsed dye laser efficacy is equal to LED photodynamic therapy.Purple type of LED photodynamic therapy treatment is superior to pulsed dye laser.LED light source is expected as a new light source to promote clinical application and promotion of PWS photodynamic therapy.