Home  About us  Contact
 

Wine Stains (wine + stain)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Wine Stains

  • port wine stain
    		•

    Selected Abstracts

    Pilot study examining the combined use of pulsed dye laser and topical Imiquimod versus laser alone for treatment of port wine stain birthmarks

    LASERS IN SURGERY AND MEDICINE, Issue 9 2008
    Cheng-Jen Chang MD
    Abstract Background and Objective The objective of this study was to improve port wine stain (PWS) therapeutic outcome in response to laser therapy. Our specific aim was to determine whether the combined use of pulsed dye laser (PDL) therapy and topical Imiquimod versus PDL alone can improve PWS therapeutic outcome. Study Design/Materials and Methods This pilot study involved a retrospective review of 20 subjects, all Asian, with PWS. Subject ages ranged between 3 and 56 years. Upon enrollment, three test sites were prospectively identified on each subject for treatment assignments to the following regimens: (A) PDL+Imiquimod; (B) PDL alone; and (C) Imiquimod alone. PDL test sites received a single treatment with a 585 nm wavelength; 1.5 milliseconds pulse duration; spot size 7 mm using a light dosage of 10 J/cm2 with cryogen spray cooling. For the PDL+Imiquimod and Imiquimod alone test sites, subjects were instructed to apply Imiquimod topically to the sites once daily for 1 month after PDL exposure. Subjects were followed-up at 1, 3, 6, and 12 months after PDL exposure to evaluate each of the three test sites. The primary efficacy measurement was the quantitative assessment of blanching responses as measured by a DermoSpectrometer to calculate the hemoglobin-index of each site at 1, 3, 6, and 12 months after PDL exposure. Subjects were also closely monitored for any adverse effects. Results Based on paired sample test analysis, there were clinically, and statistically significant, differences in blanching responses over time favoring PWS receiving PDL+Imiquimod as compared to either PDL or Imiquimod alone (P<0.05). At 12 months, it should be noted that there was some evidence of redarkening of PWS test sites treated by PDL+Imiquimod and PDL alone, presumably due to revascularization of blood vessels. However, based on comparison of the hemoglobin-indices determined at 1 and 12 months after PDL exposure, there was less revascularization of PWS test sites treated with PDL+Imiquimod as compared to PDL alone (P<0.05). Transient hyperpigmentation was noted in 10% (n,=,2) and 40% (n,=,8) of subjects on the PDL+Imiquimod and PDL alone test sites, respectively. On all sites, hyperpigmentation resolved spontaneously without medical intervention within 6 months. Permanent hypopigmentation or scarring was not observed on any test site. Conclusion Based on the results of this pilot study, PDL+Imiquimod resulted in superior blanching responses over time as compared to PDL alone for treatment of test sites on PWS lesions. Although the PDL+Imiquimod approach is intriguing, clinical validation in large PWS patient samples is required. Lesers Surg. Med. 40:605,610, 2008. © 2008 Wiley-Liss, Inc. [source]

    Noninvasive blood flow imaging for real-time feedback during laser therapy of port wine stain birthmarks

    LASERS IN SURGERY AND MEDICINE, Issue 3 2008
    Yu-Chih Huang MS
    Abstract Background and Objectives During laser therapy of port wine stain (PWS) birthmarks, regions of persistent perfusion may exist. Immediate retreatment of such regions may improve PWS laser therapeutic outcome. To address this need, we propose use of laser speckle imaging (LSI) to provide real-time, quantitative feedback during laser surgery. Herein, we present in vitro and in vivo data collected with a clinic-based LSI instrument. Study Design/Materials and Methods Prior to clinical implementation, we first investigated three aspects of LSI deemed important for clinical imaging: (1) instrument depth of field (DOF); (2) effects of laser irradiance on speckle flow index (SFI) values; and (3) measurement repeatability. Clinical measurements were acquired from the lesions of PWS patients immediately prior to and after laser therapy at the Beckman Laser Institute. Results Our preclinical data suggest the following: (1) instrument DOF was ,1 cm; (2) quantitative flow characterization with LSI was practically unaffected at normalized irradiance values between 0.06 and 0.5; and (3) our LSI instrument was capable of highly reproducible SFI values. From our clinical measurements, we found that the relative difference between blood perfusion in PWS lesions and adjacent normal skin was highly variable. Based on SFI images, the perfusion of PWS skin is sometimes indistinguishable from that of adjacent normal skin. With laser therapy, we measured a global decrease in blood perfusion, and we frequently observed distinct regions of persistent perfusion. Conclusions Our results demonstrate the potential role of image-guided laser therapy of PWS birthmarks. LSI is a promising tool for noninvasive blood flow characterization during laser therapy due to its relative simplicity and low cost. Laser Surg. Med. 40:167,173, 2008. © 2008 Wiley-Liss, Inc. [source]

    Improvement of port wine stain laser therapy by skin preheating prior to cryogen spray cooling: A numerical simulation

    LASERS IN SURGERY AND MEDICINE, Issue 2 2006
    Wangcun Jia PhD
    Abstract Background and Objectives Although cryogen spray cooling (CSC) in conjunction with laser therapy has become the clinical standard for treatment of port wine stain (PWS) birthmarks, the current approach does not produce complete lesion blanching in the vast majority of patients. The objectives of this study are to: (1) experimentally determine the dynamic CSC heat flux when a skin phantom is preheated, and (2) numerically study the feasibility of using skin preheating prior to CSC to improve PWS laser therapeutic outcome. Study Design/Materials and Methods A fast-response thin-foil thermocouple was used to measure the surface temperature and thus heat flux of an epoxy skin phantom during CSC. Using the heat flux as a boundary condition, PWS laser therapy was simulated with finite element heat diffusion and Monte Carlo light distribution models. Epidermal and PWS blood vessel thermal damage were calculated with an Arrhenius-type kinetic model. Results Experimental results show that the skin phantom surface can be cooled to a similar minimum temperature regardless of the initial temperature. Numerical simulation indicates that upon laser irradiation, the epidermal temperature increase is virtually unaffected by preheating, while higher PWS blood vessel temperatures can be achieved. Based on the damage criterion we assumed, the depth and maximum diameter of PWS vessels that can be destroyed irreversibly with skin preheating are greater than those without. Conclusions Skin preheating prior to CSC can maintain epidermal cooling while increasing PWS blood vessel temperature before laser irradiation. Numerical models have been developed to show that patients may benefit from the skin preheating approach, depending on PWS vessel diameter and depth. Lasers Surg. Med. 38:155,162, 2006. © 2006 Wiley-Liss, Inc. [source]

    Port wine stain treatment with a dual-wavelength Nd:Yag laser and cryogen spray cooling: A pilot study,

    LASERS IN SURGERY AND MEDICINE, Issue 2 2004
    an MD
    Abstract Background and Objectives We report on a pilot study of port wine stain (PWS) treatment with a prototype Nd:YAG/KTP laser system, emitting simultaneously at 1,064 and 532 nm, and equipped with a cryogen spray cooling (CSC) device. Study Design/Patients and Methods On 10 patients (4,36 years old, mean: 16.2 years) with skin types II-III, therapeutic efficacy of the dual-wavelength laser (KTP+) was compared with a standard KTP laser (532 nm only) at the same pulse duration (25 millisecond), spot diameter (3 mm), and CSC parameters. The fluences were selected in order to obtain the same immediate response with both laser systems. Blanching of each test segment was assessed 8 weeks post treatment by an independent evaluator and by the subjects, and graded on a 1,4 scale. Results Significant blanching of PWS was noted 8 weeks after a single therapeutic session with the KTP+ laser (mean: 532 nm radiant exposure: 8.2 J/cm2), very similar to that observed with KTP at 12.4 J/cm2. The evaluator noticed a slight brownish coloration in areas treated with the KTP+ laser. Isolated beam-sized atrophic scars were present in two patients where KTP+ (9 and 10 J/cm2) and KTP (14 J/cm2) lasers were used. Conclusions The addition of 1,064 nm radiation allowed a significant reduction of 532 nm radiant exposure with no loss of efficacy in PWS treatment. Lasers Surg. Med. 34:164,167, 2004. © 2004 Wiley-Liss, Inc. [source]

    A prospective study of the impact of laser treatment on vascular lesions

    BRITISH JOURNAL OF DERMATOLOGY, Issue 2 2000
    G. Gupta
    Background,Vascular lesions, especially on exposed sites, can be unsightly and may cause significant psychological distress. Lasers are effective in treating such lesions, but relatively few studies have been performed looking at psychological scoring before and after laser therapy. Objectives,To assess the change in psychological distress in patients with vascular lesions following laser treatment. Patients and methods,A prospective study was performed with patients recruited over a 3-month period. Psychological distress was measured using subjective scores on a standard questionnaire before treatment and at a 6-month follow-up. Each patient was treated every 4,8 weeks with an appropriate laser by the same dermatologist until discharge. Forty-two patients were recruited with one of four diagnoses: telangiectasia, port wine stain (PWS), vascular spider or cherry angioma, which occurred mainly on facial or exposed sites. Results,Following laser treatment, there was a significant decrease in subjective scores of patients with telangiectasia and vascular spiders. Patients with PWS showed objective improvement but this was not reflected in their subjective scores. Psychological distress had reduced significantly in patients with less severe vascular lesions. Conclusions,Laser treatment of minor vascular lesions leads to objective improvement, which is paralleled by psychological benefit, but objective benefit in PWS may not be perceived as beneficial by patients. [source]

    Thorium X treatment: multiple basal cell carcinomas within a port-wine stain

    CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2009
    J. Natkunarajah
    Summary Thorium X is an ionizing radiation treatment that was commonly used by dermatologists in the 1930 s to 1950 s to treat a variety of benign dermatoses and vascular lesions including port-wine stains. By the 1960 s, thorium X was discontinued due to poor clinical results and the carcinogenic potential. We report a 64-year-old man with a history of multiple basal cell carcinomas in a facial port wine stain, which had previously been treated with thorium X. [source]

    Treatment of port wine stains with photodynamic therapy, using pulsed dye laser as a Light Source, Compared With Pulsed dye laser alone: A pilot study,

    LASERS IN SURGERY AND MEDICINE, Issue 4 2005
    Alun V. Evans MRCP
    Abstract Background and Objectives Laser-induced photo thermal damage has been combined with photodynamic therapy (PDT) using a systemic photosensitiser to treat vascular lesions. The efficacy of PDT using systemic 5-aminolaevulinic acid (5-ALA) as the photosensitiser and pulsed dye laser (PDL) as the light source in port wine stains (PWS) is unknown. Study Designs/Materials and Methods We conducted an internally controlled pilot study comparing the efficacy of PDT using PDL as a light source, to PDL alone in the treatment of PWS. Results The PWS improved slightly in all patients but no significant difference was found between the three treatment arms in terms of lesional lightening or incidence and severity of side effects. Conclusions There was no evidence of increased efficacy of PDT using PDL as a light source compared to PDL alone. There was also no significant difference in adverse events. Further studies using different treatment regimens over longer periods of time may be warranted. © 2005 Wiley-Liss, Inc. [source]

    Prospective study of port wine stain treatment with dye laser: Comparison of two wavelengths (585 nm vs.

    LASERS IN SURGERY AND MEDICINE, Issue 2 2004
    595 nm), two pulse durations (0.5 milliseconds vs.
    Abstract Background and Objectives The conventional pulsed-dye laser (wavelength 585 nm, pulse duration 0.5 milliseconds) is seen as the standard treatment for port wine stains (PWS). Using the pulsed-dye laser at wavelengths of 590, 595, and 600 nm and at varying pulse durations of 1.5,40 milliseconds is one of the newest developments in the field, the therapeutic value of which has been examined in only a few studies. Treatment of PWS with short- and long-pulse dye lasers. Comparison of two wavelengths (585 nm vs. 595 nm) and two pulse durations (0.5 milliseconds vs. 20 milliseconds). Study Design/Materials and Methods Fifteen patients with untreated PWS were included in a randomized prospective study with three different laser settings. Patients underwent one treatment session. The following treatment parameters were chosen at a uniform spot size of 7 mm: (1) 585 nm/0.5 milliseconds/5.5 J/cm2, (2) 595 nm/0.5 milliseconds/5.5 J/cm2, and (3) 595 nm/20 milliseconds/13 J/cm2. The clearance as well as side effects was evaluated. All treatments were performed with cold air-cooling. Follow-up took place immediately, 2 days and 4 weeks after the treatment. The PWS was assigned a clearance score (CS) from 1 to 4 (1,=,poor to 4,=,excellent). Results Descriptively, 585 nm/0.5 milliseconds generated the best average CS of 2.7, followed by 595 nm/20 milliseconds (2.5) and 595 nm/0.5 milliseconds (1.6)); statistically, there is no difference between the CS of 585 nm/0.5 milliseconds and 595 nm/20 milliseconds. The best lightening rates overall were achieved in purple PWS (CS,=,3.5) versus red (CS,=,2.5) and pink (CS,=,2.0). Purple PWS responded best to 585 nm/0.5 milliseconds; red and pink PWS yielded similar results with 585 nm/0.5 milliseconds and 595 nm/20 milliseconds. The setting, 595 nm/0.5 milliseconds was clearly not as effective as the other laser settings. Purpura, pain, and crusting were most commonly reported after treatments with 585 nm/0.5 milliseconds (93%/93%/33%), closely followed by treatments at 595 nm/20 milliseconds (86%/93%/20%). The settings 595 nm/0.5 milliseconds yielded the lowest rate of adverse effects (67%/60%/0%). Hypopigmentation only occurred in one case (585 nm/0.5 milliseconds), and there were no reports of hyperpigmentation or scarring. Conclusions With respect to treating PWS, the conventional pulsed-dye laser set to 585 nm/0.5 milliseconds yields a significantly greater clearance rate than it does at a setting of 595 nm (with the same pulse duration, fluence, and spot size), although the former also entails the highest spectrum of adverse effects. In this study, purple PWS treated at these parameters showed the best results. In dealing with pink PWS, the results were similar to those of the conventional pulsed-dye laser when the pulse duration was increased to 20 milliseconds and fluence was increased. As a rule, the clearance rate corresponded to the extent of the postoperative purpura. Lasers Surg. Med. 34:168,173, 2004. © 2004 Wiley-Liss, Inc. [source]

    Vascular response to laser photothermolysis as a function of pulse duration, vessel type, and diameter: Implications for port wine stain laser therapy

    LASERS IN SURGERY AND MEDICINE, Issue 2 2002
    Sol Kimel PhD
    Abstract Background and Objective Treatment of port wine stains (PWS) by photothermolysis can be improved by optimizing laser parameters on an individual patient basis. We have studied the critical role of pulse duration (tp) on the treatment efficacy. Study Design/Materials and Methods The V-beam laser (Candela) allowed changing tp over user-specified discrete values between 1.5 and 40 milliseconds by delivering a series of 100 microsecond spikes. For the 1.5 and 3 millisecond pulses, three spikes were observed at intervals tp/2 and for tp,,,6 milliseconds, four spikes separated by tp/3. The ScleroPlus laser (Candela) has a smooth output over its fixed 1.5 milliseconds duration. Blood vessels in the chick chorioallantoic membrane (CAM) were irradiated at fixed wavelength (595 nm), spot size (7 mm), radiant exposure (15 Jcm,2), and at variable tp. The CAM contains an extensive microvascular network ranging from capillaries with diameter D,<,30 ,m to blood vessels of D,,,120 ,m. The CAM assay allows real-time video documentation, and observation of blood flow in pre-capillary arterioles (A) and post-capillary venules (V). Vessel injury was graded from recorded videotapes. Mathematical modeling was developed to interpret results of vessel injury when varying tp and D. A modified thermal relaxation time was introduced to calculate vessel wall temperature following laser exposure. Results Arterioles. For increasing tp, overall damage was found to decrease. For fixed tp, damage decreased with vessel size. Venules. For all D, damage was smaller than for corresponding arterioles. There was no dependence of damage on tp. For given tp, no variation of damage with D was observed. Photothermolysis due to spiked (V-beam) vs. smooth (Scleroplus) delivery of laser energy at fixed tp (1.5 milliseconds), showed similar vessel injuries for al values of D (P>0.05). Conclusions The difference between initial arteriole and venule damage could be explained by the threefold higher absorption coefficient at 595 nm in (oxygen-poor!) arterioles. In human patients, PWS consist of ectatic venules (characterized by higher absorption), so that these considerations favor the use of 595-nm irradiation for laser photothermolysis. For optimal treatment of PWS it is proposed that tp be between 0.1 and 1.5 milliseconds. This is based on a modified relaxation time ,d,, defined as the time required for heat conduction into the full thickness of the vessel wall, which is assumed to have a thickness ,D ,,0.1D. The corresponding ,d, will be a factor of about six smaller than given in the literature. For vessels with D between 30 and 300 ,m, ,d, ranges from 0.1 to 1.5 milliseconds. Lasers Surg. Med. 30:160,169, 2002. © 2002 Wiley-Liss, Inc. [source]

    Histologic evaluation of skin damage after overlapping and nonoverlapping flashlamp pumped pulsed dye laser pulses: A study on normal human skin as a model for port wine stains

    LASERS IN SURGERY AND MEDICINE, Issue 2 2001
    Petra H.L. Koster MD
    Abstract Background and Objective In the treatment of port wine stains (PWS) with the flashlamp pumped pulsed dye laser (FPPDL), no consensus exists about overlapping of pulses. The advantage of overlapping pulses is homogeneous lightening of the PWS; the risk is redundant tissue damage. The aim of this study was to determine the histopathologic effect on human skin of pulsed dye laser pulses with various degrees of overlap, with normal human skin as a model for PWS. Study Design/Materials and Methods Eighteen healthy white volunteers were irradiated with pulsed dye laser pulses with increasing radiant exposure and with different degrees of overlap. Biopsy samples were taken and histologically analysed. Results Overlapping of pulses on normal human skin enhances depth of vascular damage with approximately 30%. Adjacent pulses also show this effect. We found no histologic signs of serious damage to epidermis or dermal connective tissue by using radiant exposure levels of 6,8 J/cm2, regardless of pulse application. Conclusions Reasoning that the mechanism of tissue injury is comparable for normal and PWS skin, we conclude that it is safe to treat PWS with overlapping FPPDL pulses to achieve homogeneous lightening. Lasers Surg. Med. 28:176,181, 2001. © 2001 Wiley-Liss, Inc. [source]

    A comparative study of a 595-nm with a 585-nm pulsed dye laser in refractory port wine stains

    BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2005
    A. Yung
    Summary Background, The pulsed dye laser (PDL) is the treatment of choice for port wine stains (PWS); however, some patients' PWS become refractory to further treatments. Technological advances have enabled new machines with the advent of surface cooling devices to deliver longer wavelengths and higher fluence more safely. These advances have the potential to achieve improved response rates in refractory PWS. There are few studies comparing the efficacy of standard PDL treatments for refractory PWS with the wider choice of treatment variables available from newer PDL machines. Objectives, To determine if there is any advantage of using a longer wavelength (595 nm) and pulse widths (1·5 ms, 6 ms and 20 ms) over conventional PDL settings (wavelength 585 nm, pulse width 1·5 ms) in refractory PWS. Methods, Eighteen consecutive consenting patients with Fitzpatrick skin types 1,4 with a mean age 35 years (range 17,59 years) with refractory PWS were treated routinely with three separate test areas using 595-nm PDL (using three different pulse width settings of 1·5 ms, 6 ms and 20 ms), compared with test areas treated with 585-nm PDL (pulse width 1·5 ms). All test areas were treated with an identical fluence (15 J cm,2), spot size (7 mm) and cooling setting (dynamic cooling 60 ms, delay 60 ms). Results, We found a statistically significant advantage of 595-nm PDL (pulse width 1·5 ms) over 595-nm PDL (pulse width 6 ms) (P < 0·05) in the treatment of refractory PWS; however, we found no significant advantage using longer pulse widths of 20 ms compared with 1·5 ms with the 595-nm PDL. There was no statistically significant advantage in using a 595-nm PDL over a 585-nm PDL using identical pulse widths of 1·5 ms, spot size, fluence and cryogen cooling settings; however, the number of directly comparable test areas was smaller. Some individual patients in our study obtained a better response with certain 595-nm PDL settings (pulse width 1·5 ms and 6 ms) compared with 585-nm PDL (pulse width 1·5 ms). Conclusions, Our experience of high fluence PDL in the treatment of refractory PWS suggests patients treated with 585 nm (pulse width 1·5 ms) improve to a similar degree as patients treated with 595-nm PDL (pulse width 1·5 ms). However, the use of the 595-nm PDL with longer pulse widths yields no extra advantage. For those patients who have failed to improve with high-fluence 585-nm PDL (pulse width 1·5 ms), test areas using 595-nm PDL (pulse width 1·5 ms and 6 ms) should be undertaken to ascertain if individual patients may benefit from the longer pulse width 595-nm PDL. [source]