鲜红斑痣的临床治疗进展

鲜红斑痣又称葡萄酒色斑(port wine stains,PWS),是常见的先天性血管畸形,其特征是真皮中毛细血管和小静脉畸形扩张.PWS人群中的发病率0.3％～0.5％,通常发生在面部、颈部和其他暴露部位,表现为先天性皮肤和(或)黏膜上的红斑.如果不进行治疗,随着年龄增长皮损颜色逐渐增厚加深,最终形成结节样增生.目前...     

鲜红斑痣的治疗及进展

鲜红斑痣是一种先天性毛细血管畸形,在新生儿中发病率约为0.3%,一般无自行消退倾向,未经治疗或治疗不充分可随着年龄增大而进展,面积变大、颜色变深,颜色由粉红变为紫红,甚至增厚出现结节、化脓性肉芽肿,引起自发性出血或创伤后出血等不良预后。传统方法因副作用大、疗效欠佳,大部分已淘汰,目前激光及光动力疗法发展迅速,成为鲜红斑痣的主流治疗方法,新的治疗思路也不断涌现。文章对PWS常用治疗方法及进展进行综述。     

光动力在鲜红斑痣治疗中的应用进展

鲜红斑痣(PWS)是一种常见的先天性血管性疾病,光动力在治疗PWS方面研究取得了较好的成效,尤其对大面积、紫红型及治疗抵抗型PWS起到了较为理想的疗效,但治疗后可出现疼痛、肿胀、渗出、结痂等不良反应。本文将综述并探讨现有光动力疗法在PWS治疗中的应用进展及优缺点,为PWS的治疗提供理论依据。     

泵脉冲染料激光治疗194例鲜红斑痣疗效分析

鲜红斑痣为一种先天的皮肤毛细血管发育异常,在皮肤的浅层形成毛细血管丛,其发病率为０．３％,大部分发生面部和颈部,约８５％的患者发生在单侧,严重影响了患者的面容,疾病在出生时为淡红色斑,逐渐发展为暗红色斑或紫红色斑,部分可出现结节,在成人时皮损面积也增大［１］。泵脉冲染料激光是第一个根据选择性光动力学原理制造的激光机,它可选择性的破坏毛细血管而不损坏周围的真皮和表皮。研究表明泵脉冲染料激光治疗鲜红斑痣是有效和安全的［２］。 北京协和医院于１９９８年开始使用美国塞诺秀公司生产的 Ｐｈｏｔｌｏ Ｇｅｎｉ…     

难治性鲜红斑痣的治疗进展

鲜红斑痣（PWS）是一种常见的先天血管畸形,随着患者的年龄增长,颜色逐渐加深,皮损增厚甚至形成结节。脉冲染料激光（PDL）利用选择性光热作用原理治疗PWS,是临床治疗的标准方法。然而,对于部分难治性PWS,单纯PDL治疗很难达到理想的效果,甚至根本没有作用。针对其现状,本文对增厚及结节形成的这类难治性PWS的多种治疗方法进行了概述,为临床治疗提供一些参考依据。     

可变脉宽1064nm Nd:YAG激光联合强脉冲光治疗鲜红斑痣疗效评价

目的:评价可变脉宽1064 nm Nd:YAG激光联合强脉冲光(IPL)治疗鲜红斑痣的疗效。方法:将329例鲜红斑痣患者随机分为2组,分别给予可变脉宽Nd:YAG 1064 nm激光单独照射(165例)以及可变脉宽Nd:YAG 1064 nm激光与强脉冲光联合照射(164例)。结果:联合治疗组总有效率(91.46%)优于单独照射组(79.96%),P0.01。结论:可变脉宽1064 nm Nd:YAG激光联合IPL较单独可变脉宽Nd:YAG 1064 nm激光治疗鲜红斑痣有效。     

脉冲染料激光治疗鲜红斑痣的临床疗效分析

利用脉冲染料激光器治疗了1617例鲜红 斑痣患者,并从年龄的大小、皮损类型、面积大小、发生的部位及副作用进行了分组观察研究。其年龄小、淡红型 皮损,面积小、发生于颈部、面部偏侧者疗效显著。1617例中仅有1例下唇发生轻度增生性瘢痕。由此认为脉冲染料激光是目前治疗鲜红斑痣安全有效的方法。     

595nm脉冲染料激光治疗鲜红斑痣回顾性分析

目的观察595nm脉冲染料激光治疗鲜红斑痣的临床疗效。方法应用595nm脉冲染料激光治疗647例鲜红斑痣患者,观察临床疗效及副作用。结果粉红型、鲜红/紫红型及增厚/结节型平均治疗次数分别为3.61次、4.87次及4.57次。随着治疗次数的增加,疗效逐渐提高。粉红型、鲜红/紫红型及增厚/结节型的总有效率分别为80.24%,75.86%及65.21%。经Chi-square检验,前两型疗效无统计学差异,但均优于后者。术后副作用少。结论595nm脉冲染料激光治疗鲜红斑痣疗效确切,安全性高。     

595nm脉冲染料激光治疗儿童鲜红斑痣69例疗效观察

目的:观察595 nm脉冲染料激光治疗儿童鲜红斑痣的临床疗效。方法:选取来我院就诊的儿童面颈部鲜红斑痣69例,其中粉红型52例、紫红型11例,增厚型6例,采用595 nm脉冲染料激光进行治疗。比较儿童不同类型鲜红斑痣的疗效。结果:鲜红斑痣中粉红型总有效率为100%,紫红型和增厚型的总有效率分别90.91%和83.33%。粉红型与紫红型间总有效率差异无统计学意义(2=1.95,P0.05);而粉红型与增厚型(2=64.46,P0.05)、紫红型与增厚型(2=57.32,P0.05)间总有效率差异有统计学意义。结论:595 nm脉冲染料激光治疗儿童皮肤鲜红斑痣疗效确切。粉红型及紫红型鲜红斑痣疗效较增厚型鲜红斑痣好。     

595nm脉冲染料激光治疗儿童鲜红斑痣69例疗效观察

目的:观察595 nm脉冲染料激光治疗儿童鲜红斑痣的临床疗效。方法:选取来我院就诊的儿童面颈部鲜红斑痣69例,其中粉红型52例、紫红型11例,增厚型6例,采用595 nm脉冲染料激光进行治疗。比较儿童不同类型鲜红斑痣的疗效。结果:鲜红斑痣中粉红型总有效率为100%,紫红型和增厚型的总有效率分别90.91%和83.33%。粉红型与紫红型间总有效率差异无统计学意义(2=1.95,P>0.05);而粉红型与增厚型(2=64.46,P<0.05)、紫红型与增厚型(2=57.32,P<0.05)间总有效率差异有统计学意义。结论:595 nm脉冲染料激光治疗儿童皮肤鲜红斑痣疗效确切。粉红型及紫红型鲜红斑痣疗效较增厚型鲜红斑痣好。     

Efficacy of a novel intense pulsed light system for the treatment of port wine stains

Abstract

Background and objectives: Port wine stains (PWS) are capillary malformations typically treated with lasers or with intense pulsed light (IPL). This paper summarizes our safety and efficacy findings for a new IPL designed to target the dermal vessels of PWS. Methods: The PWS received three to four treatments with a novel IPL containing a vascular-specific handpiece (LuxG?, dual wavelength band of 500–670 nm and 870–1400 nm; Palomar Medical Technologies, Inc.). Clinical benefit was assessed qualitatively with a quartile-assessment scale and quantitatively with a skinphotometer. Results: Three months post-treatment, over 50% of PWS exhibited statistically significant improvements of 51–75% or higher. The pre-treatment PWS mean erythema value of 189.72±18.40 (95% Confidence Interval [CI]) was reduced to 147.22±16.15 post-treatment, thereby approaching the normal skin erythema value of 117.61 ± 15.90. The mean percent reduction in vascularity at 3 months was statistically significant at ?55.4 (p=0.0000003). Treatments were well-tolerated with minimal to no subject downtime and limited side effects of transient erythema (all subjects) or mild crusting and mild purpura (n=1). Conclusion: These results demonstrate the efficacy and safety of this novel IPL in providing therapeutic benefit to patients suffering from PWS.     

脉冲染料激光治疗鲜红斑痣的临床疗效评价

目的：探讨影响脉冲染料激光治疗鲜红斑痣疗效的相关因素。方法：应用脉冲染料激光治疗130例鲜红斑痣患者,分析疗效与患者年龄、皮损颜色和病变部位的关系。结果：130例患者经脉冲染料激光治疗有效率为56．2％;经Spearman相关分析．疗效与患者年龄、皮损颜色和部位有相关性;患者年龄越小、皮损颜色越浅疗效越好;项部、耳后部、额颞部皮损疗效显著好于唇部、四肢。结论：脉冲染料激光治疗鲜红斑痣的临床疗效与多种因素相关,宜在婴幼儿期进行治疗。     

Ultrastructural observations in port wine stains

Summary The cause for the progressive vascular dilatation in port wine stains remains unclear. We compared the histology and ultrastructure of lesional and adjacent normal skin in paired biopsy specimens of 12 and 8 patients, respectively (age range, 6 to 53 years). In semithin sections, the lesions of all patients showed ectatic vessels and a fine-fibrous or hyaline thickening of the walls of postcapillary venules, as well as in some instances a loosening of the surrounding connective tissue. Ultrastructurally, the wall material consisted predominantly of peripheral deposits of amorphous material interspersed with collagen fibrils (diameter, 35±4 nm); occasionally the number of basal laminae in the inner part was also increased. Cross-banded filamentous aggregates with a periodicity of 95 nm were observed in and around the walls. The endothelium of many patients displayed fenestrations and/or small gaps. Various kinds of alterations of the intervascular connective tissue were found. We conclude that structural alterations of the vascular and later also of the intervascular connective tissue are related to the dilatation of the vessels. These findings are in agreement with the immunopathologically demonstrated increase of basement membrane components in the same biopsy specimens, but are interpreted as secondary phenomena. Endothelial stability and permeability may also be affected.Presented in part at the 14th Annual Meeting of the Society for Cutaneous Ultrastructural Research, 8–10 July, 1987, Edinburgh, Scotland     

Laser-induced primary and secondary hemostasis dynamics and mechanisms in relation to selective photothermolysis of port wine stains

Background

Superficial vascular anomalies such as port wine stains are commonly treated by selective photothermolysis (SP). The endovascular laser-tissue interactions underlying SP are governed by a photothermal response (thermocoagulation of blood) and a hemodynamic response (thrombosis). Currently it is not known whether the hemodynamic response encompasses both primary and secondary hemostasis, which platelet receptors are involved, and what the SP-induced thrombosis kinetics are in low-flow venules.

Objectives

To (1) define the role and kinetics of primary and secondary hemostasis in laser-induced thrombus formation and (2) determine which key platelet surface receptors are involved in the hemodynamic response.

Methods

532-nm laser-irradiated hamster dorsal skin fold venules were studied by intravital fluorescence microscopy following fluorescent labeling of platelets with 5(6)-carboxyfluorescein. Heparin and fluorescently labeled anti-glycoprotein Ib-α (GPIbα) and anti-P-selectin antibodies were administered to investigate the role of coagulation and platelet receptors, respectively. Lesional sizes were quantified by software.

Results

Laser irradiation consistently produced sub-occlusive thermal coagula. Thrombosis was triggered in all irradiated venules in a thermal coagulum-independent manner and peaked at 6.25 min post-irradiation. Heparin decreased the maximum thrombus size and caused thrombosis to reach a maximum at 1.25 min. Immunoblocking of GPIbα abated the extent of thrombosis, whereas immunoblocking of P-selectin had no effect.

Conclusions

The hemodynamic response ensues the photothermal response in a thermal coagulum-independent manner and involves primary and secondary hemostasis. Primary hemostasis is mediated by constitutively expressed GPIbα but not by activation-dependent P-selectin.     

激光和强脉冲光治疗酒渣鼻的治疗进展

酒渣鼻是常见皮肤病,其临床特点包括皮肤潮红、持久性红斑、丘疹脓疱和毛细血管扩张.激光是治疗酒渣鼻毛细血管扩张和鼻赘期的理想选择,最常用的激光包括脉冲染料激光(波长585/595 nm)、长脉宽Nd:YAG激光(波长1064 nm)、CO2激光、铒激光和点阵激光等.强脉冲光、脉冲染料激光用于改善酒渣鼻红斑和毛细血管扩张,安全性高,停工期短.长脉宽Nd:YAG激光仅用于治疗较粗血管和难治性毛细血管扩张.CO2激光、铒激光和点阵激光用于改善酒渣鼻鼻赘.临床上多种激光联合治疗效果更佳.     

Evaluation of fluence and pulse-duration on purpuric threshold using an extended pulse pulsed-dye laser in the treatment of port wine stains

Laser therapy of port-wine stains (PWS) using the extended pulse pulsed-dye laser (EPPDL) is accepted as the optimal approach because the thermal relaxation time for the vessels in PWS is actually 1-10 msec. The purpose of this study is to elucidate the purpuric threshold using the EPPDL for treatment of PWS. One hundred and seventy-seven Japanese patients with PWS were recruited for this study. All the patients were dark-skinned with skin phototype III (n = 103) and IV (n = 74). PWS were treated with the EPPDL with a pulse duration ranging 1.5-10 msec, fluence ranging 9-15 J/cm(2), and a spot size of 7 mm. Cryogen spray cooling (CSC) was fixed to 30 msec of delay and 30 msec of spray duration. Patients returned to our clinic within 1 week after their initial laser therapy and the treatment sites were examined for the evidence of purpura formation. Of the 177 patients, 108 developed purpura. The lowest fluences that caused purpura and were seen in more than 50% of patients were 10 J/cm(2) with a pulse duration of 1.5 msec, 12 J/cm(2) with a pulse duration of 3 msec, 13 J/cm(2) with a pulse duration of 6 msec, and 13 J/cm(2) with a pulse duration of 10 msec. The fluence and pulse duration thresholds were 12.5 J/cm(2) and 1.65 msec, respectively. Because purpura is one of the treatment endpoints when using a pulsed-dye laser for PWS, higher fluences are necessary when using a long pulse duration.     

Immediate post‐irradiation dermoscopic vascular changes versus purpura as a therapeutic endpoint in pulsed‐dye laser treatment of port wine stains

Pulsed‐dye laser (PDL) is the treatment of choice for port wine stain (PWS), and the development of purpura is considered a therapeutic endpoint. Changes in PWS vasculature observed by dermoscopy immediately after laser irradiation have been suggested to predict the minimal effective fluence. The current study aimed at comparing these changes with purpura as a therapeutic endpoint. Fifty‐six PWS patients, randomized into two groups, received five monthly PDL sessions (595 nm and 10 mm spot size). At the first visit, patients received multiple gradually increasing test irradiations. Patients in the first group were treated with the lowest dose that resulted in 24‐hr‐lasting purpura, while patients in the second group were treated with the lowest dose that resulted in vessel disappearance observed by dermoscope. No statistically significant differences were observed between the two groups (the dermoscopic and the purpuric) regarding mean average improvement (42.4 and 37.32%, respectively, p = .32), grade of improvement (p = .44), and the rate of side effects (0 and 13.79%, respectively, p = .13). In conclusion, the immediate post‐irradiation vessel disappearance (detected by dermoscope) is comparable, in safety and efficacy, to purpura as a therapeutic endpoint and maybe more time‐saving and more accepted cosmetically.     

新型强脉冲光治疗面部寻常痤疮的疗效观察

2005年7月至2007年8月,我科用具有优化脉冲技术的新型强脉冲光(intense pulsed light,IPL)治疗116例面部寻常痤疮患者,取得满意疗效. 一、临床资料 依据靳培英[1]标准,寻常痤疮严重程度分为轻(Ⅰ级)、中(Ⅱ级和Ⅲ级)、重(Ⅳ级),选择病情为Ⅱ～Ⅲ级的面部寻常痤疮患者116例,男46例,女70例;年龄18～42岁,平均(23.12±5.34)岁;病程2个月至13年,平均(2.76±1.58)年.其中Ⅱ级79例:有粉刺,伴有中等量的丘疹和脓疱,总数31～50个;Ⅲ级37例:有粉刺,伴有大量的丘疹和脓疱,偶见大的炎性损害,分布广泛,总数51～100个,有少数结节.排除标准:有光敏史者;1年内外用或口服光敏性药物者,如维A酸类药物;近期内服用其他药物(如糖皮质激素)者;正在使用其他方法治疗痤疮者;2周内经受日光曝晒者;妊娠及哺乳期患者;有精神疾患者.