Histological analysis of different types of port-wine stains to guide clinical decision making: A retrospective study

Background and objectives: Port-wine stains are defined as congenital benign vascular lesions. The treatment of port-wine stains remains a challenge, worldwide. This study aimed to analyze the histological characteristics in different types of port-wine stains and provide guidance for clinical decision-making. Methods and materials: Biopsies were from the hospital from 2015 to 2021. H&E staining, Immunofluorescence staining, Masson’s trichrome staining and Weigert staining were performed on the tissues. Results: A total of 35 port-wine stains patients were included in the study of four distinct types, namely red port-wine stains (11 cases), purple port-wine stains (seven cases), hypertrophic port-wine stains (nine cases) and nodular port-wine stains (eight cases). The mean vessel diameter of the different types was 38.7 ± 5.9 ?m, 93.5 ± 9.7 ?m, 155.6 ± 21.8 ?m and 155.6 ± 29.54 ?m, respectively. Mean vessel depth was 396.4 ± 31 ?m, 944.2 ± 105.4 ?m, 2,971 ± 161.3 ?m and 3,594 ± 364.6 ?m, respectively. The vessels in red port-wine stains, purple port-wine stains and hypertrophic port-wine stains were mainly composed of capillary and venous malformations, whereas those in nodular port-wine stains were venous or arteriovenous malformations. Limitation: The main limitation of the current study was the small number of patients. Conclusion: As the disease progresses, vessel diameters become larger, the vessel wall becomes thicker and vessels were found in a greater depth. A treatment plan should be scientifically formulated keeping in mind the histological characteristics of port-wine stains.

Treatment of infantile port-wine stains with pulsed dye laser: split lesion randomized comparative study between three sessions and seven sessions / 中华整形外科杂志

Objective@#To compare the safety and efficacy of pulsed dye laser (PDL) with different sessios for the East Asian infants with port-wine stains(PWS).@*Methods@#From September 2016 to September 2017, 24 East Asian infants with untreated PWS, who met the standards of enrollment, received seven treatments by PDL at 2-week intervals and three treatments at 6-week intervals at adjacent locations in each patient 2 months after final treatment. The efficacy outcome was compared with Wilcoxon signed-rank test, while the safety was compared using Fisher′s exact test.@*Results@#Of the 24 patients, 20 completed study. Seven patients had multiple sites, given a total of 62 treated PWS sites. Among the patients, 18 had lesions on the face and 2 on the extremities. The average blanching rate was (43.71 ± 27.16) % and (43.29 ± 31.58) % for PDL treatments with 7- and 3- sessions, respectively (P>0.05). The result was consistent with independent observer assessment judging that the result of 7 laser treatments was equally with that of 3 treatments (r=0.416, P=0.0008). The average grade was 3.58 ± 1.21 and 3.53 ± 1.16 for 7- and 3-sessions. The patients treated with 7-sessions developed a little more side effects than 3-sessions, including residue purpura, pigmentation changes, eczema and dermatitis.@*Conclusions@#After three treatments of PDL, the efficacy may not necessarily increased by more frequent treatments for East Asian infantile PWS.

Clinical Experience in the Treatment of Port-Wine Stains with Blebs

BACKGROUND: The current modality of choice for the treatment of Port-wine stains (PWS) is laser photocoagulation. Laser therapy for the treatment of PWS, especially with a pulsed dye laser (PDL), has been proven safe and effective; however, because penetration of the PDL is too shallow for an effective ablation of the blebs, treatment of blebbed PWS, using PDL, may be insufficient. OBJECTIVE: We demonstrated the clinical efficacy of a 1,064 nm long pulsed Nd:YAG laser with contact cooling device for blebbed PWS. METHODS: Twenty one patients with blebbed PWS (Fitzpatrick skin types II-V) underwent a treatment, using a 1,064 nm long pulsed Nd:YAG laser with a contact cooling device at 8-week intervals. Treatments were done using 5~6 mm spot sizes at 20~30 ms and 95~170 J/cm2. Laser parameters were adjusted in order to meet the needs of each individual patient's lesions. RESULTS: All subjects tolerated the treatments well, and showed clinical improvement from blebs. Of the 21 patients, 18 of them experienced either moderate or excellent response. CONCLUSION: Use of a 1,064 nm long pulsed Nd:YAG laser results in a greater depth of vascular coagulation. A 1,064 nm long pulsed Nd:YAG laser with contact cooling device may be regarded as a promising therapeutic option for the treatment of blebbed PWS.

Laser Nd: Yag e luz intensa pulsada no tratamento de mancha vinho do porto / Laser Nd: YAG and intense pulsed light in the treatment of port-wine stain: case report and review of literature

Introdução: Manchas vinho do Porto (MVP) são malformações vasculares presentes ao nascimento que podem causar alterações emocionais no paciente conforme sua localização. Tratamentos com luz intensa pulsada (LIP) e outros tipos de lasers têm sido relatados com respostas variadas. Objetivos: Revisão da literatura sobre opções terapêuticas utilizando fontes de luz nas MVP e demonstração de tratamento bem-sucedido com LIP associada a laser Nd:YAG. Método: Paciente feminina, de 14 anos, apresentando MVP na região supralabial foi tratada com a associação de laser Nd:YAG 1064nm e LIP 560nm. Foram realizadas 8 sessões com, em média, 30 dias de intervalo entre elas. Estudo realizado na Clínica Dermatológica Célia Kalil. Resultado: A paciente obteve total desaparecimento da MVP na área tratada, com o mínimo de efeitos adversos. Conclusão: A associação de LIP 560nm e laser Nd:YAG 1064nm parece ser uma alternativa adequada no tratamento das MVP.

Introduction: Port wine stains (PWS) are vascular malformations present at birth, and, depending on their location, they can cause emotional changes in the patient. Studies on the treatment of PWS with intense pulsed light (IPL) and other types of lasers presented different responses. Objectives: The objective of this study was to review the literature on the treatment options of PWS with light sources, demonstrating the success of IPL associated with Nd:YAG laser. Method: A 14 years old female patient with PWS in the supralabial region was treated with the association of 1064- nm Nd:YAG laser and 560-nm IPL. She underwent eight treatment sessions with a mean interval of 30 days between each session. The study was conducted at the Célia Kalil Dermatology Clinic. Result: The port wine stains disappeared completely with a very low incidence of adverse events. Conclusion: The association of 560-nm IPL and 1064-nm Nd:YAG laser seemed an adequate treatment alternative for PWS.

Treatment of Port Wine Stain with Nodular Change

PURPOSE: It's difficult to treat port wine stain with nodular change in Laser therapy, and many patients with port wine stain suffer from restriction in social activity in case that port wine stain located on face. We present our experience in excision of port wine stain and skin graft in two patients who had port wine stain with nodular change on their faces. METHODS: After excision of discolorized skin and nodular changed lesion of port wine stain, thick split thickness skin graft was done. RESULTS: There was no recurred nodular hypertrophy for 3 months and 3 years of follow up periods. CONCLUSION: Surgical treatments of port wine stain with nodular change can lead significant improvement of lesion and social intercourse.

Therapeutic effect of Vbeam pulsed dye laser in the treatment of port wine stains / 中华医学美学美容杂志

Objective To evaluate the clinical therapeutic effects of Vbeam 595 nm pulsed dye laser in114 cases of port wine stains.Methods 114 patients with port wine stains were treated with Vbeam 595 nm pulsed dye laser with 3～10 ms pulse width and 7mm spot size.The energy fluence used varied from 10 to 15 J/cm2.Dynamic cooling device(DCD)was used to protect epiderm,with DCD spray 30～40 ms and DCD delay 10～30 ms.The interval of therapy was 4～8 weeks.The results were graded on basis of cleaning and fading as follows:grade Ⅰ(＞75%),gradeⅡ(50%to 74%),grade Ⅲ(25%to 49%),and grade Ⅳ(＜25%).Results 114 patients completed the therapy.The number of treatments ranged from 1 to 10(mean 5.9).The results evaluated as grades Ⅰ,Ⅱ,Ⅲ and Ⅳ were 74 patients(64.9%),29 patients(25.4%),9 patients(7.9%)and 2 patients(1.8%),respectively.The therapeutic effect was analysed according to number of treatments.the ages of patients,site and color of the lesions.It was found that the therapeutic effect was prominent in patients of younger age,with pink lesions located on the neck and face.No recurrence and scar happened after 6 months to 2 years follow-up.Conclnsions Vbeam 595nm pulsed dye laser is a safe and effective method for the treatent of port wine stains,with less complications.

Application of variable pulse width frequency doubled Nd:YAG 532 nm with HELP-G laser in the treatment of port-wine stains:a report of 32 cases / 中华医学美学美容杂志

Objective To treat a group of patients with port wine stains (PWS) using a variable pulse width (VPW) frequency doubled Nd:YAG 532nm with high energy long pulse green (HELP G) laser and to evaluate the clinical efficacy, side effects and different histological changes between VPW and HELP G. Methods Thirty two patients with PWS were treated in order to study the clinical improvement by transforming from 11～16 J/cm 2 at 3 mm spot size (VPW,7～10 ms) gradually to 16～24 J/cm 2 at 4～5 mm spot size (HELP G,15～50 ms). Two patients were biopsied before and after the laser treatment.Results After treatment of 1～8 times(3.19 average), very good results were achieved in 7 PWS, and excellent results were achieved in 15 PWS.Improvement was found in 68.75 % of the patients.Conclusion VPW with HELP G laser at 532 nm appears to be an effective treatment for PWS.

A Case of Pyogenic Granuloma within Port-Wine Stain Associated with Sturge-Weber Syndrome / 대한피부과학회지

Port-wine stains(PWS) are congenital vascular birthmarks and usually isolated but may be associated with other vascular malformations. Sturge-Weber syndrome(SWS) is defined as facial PWS in association with an ipsilateral leptomeningeal vascular malformation, atrophy and calcification of the underlying cerebral cortex, epilepsy, mental retardation, contralateral hemiparesis and ipsilateral choroidal vascular lesions with glaucoma. Pyogenic granulomas or other nodular angiomatous lesions may develop within preexistent vascular malformation such as PWS. We describe a 22 year-old man who developed a pyogenic granuloma within an existing facial PWS associated with SWS.

A Case of Pyogenic Granuloma within Port-Wine Stain Associated with Sturge-Weber Syndrome / 대한피부과학회지

Port-wine stains(PWS) are congenital vascular birthmarks and usually isolated but may be associated with other vascular malformations. Sturge-Weber syndrome(SWS) is defined as facial PWS in association with an ipsilateral leptomeningeal vascular malformation, atrophy and calcification of the underlying cerebral cortex, epilepsy, mental retardation, contralateral hemiparesis and ipsilateral choroidal vascular lesions with glaucoma. Pyogenic granulomas or other nodular angiomatous lesions may develop within preexistent vascular malformation such as PWS. We describe a 22 year-old man who developed a pyogenic granuloma within an existing facial PWS associated with SWS.

Surface Cooling Effect on Epidermal Damage by 585-nm Pulsed Dye Laser

Extensive clinical research has demonstrated that the 585-nm pulsed dye laser(PDL) is effective in eradicating port-wine stains(PWS) and telangiectasia with an extremely low incidence of scarring. The successful treatment of laser therapy is based on selective photothermolysis of blood vessels without damaging the normal overlying epidermis. Unfortunately, the native epidermal melanin acts as an optical shield that absorbs the laser light and reduces the heat generated in blood vessels. When melanin absorbs laser light, the resultant temperature increase can induce epidermal blistering. In these patients, the laser treatment dosages must be kept low, often subtherapeutic, to avoid damage to the epidermis and to prevent the possibility of scarring. Cryogen spray cooling of skin may be an effective method for minimizing epidermal thermal injury. The objective of this study is to determine histologically the effectiveness of the cryogen cooling by spraying the skin with a brief spurt of cryogen prior to the laser pulse, so as to reduce epidermal damage (hypo/hyperpigmentation) caused by this laser. We present a histologic study of the thermal response of the skin of the Sprague-Dawley rats to spray cooling in conjunction with 585-nm pulsed dye laser irradiation with 6J/cm. Both treatment sites with and without the use of the cryogen spray were compared. Under light microscope, the epidermal and dermal histologic changes were compared. A significant reduction in epidermal damage was found in study groups using the cryogen cooling without changing the efficacy of the laser treatment statistically. And a significant reduction in healing periods was observed in study groups using the cryogen cooling prior to the laser pulse. This study suggests that cryogen cooling can reduce epidermal damage during PWS treatment with the 585-nm PDL without reducing treatment efficacy. The absence of epidermal damage suggests that precooling with the cryogen may allow the use of higher laser input to expedite clearance without inducing epidermal change.