Objective assessments of port wine stains: response to temperature change

Three objective measurements were made in 11 patients with facial port wine stains and in five controls. Laser Doppler flowmetry, reflectance spectrophotometry and skin surface temperature were all significantly elevated in the port wine stains compared with the normal contralateral cheeks and control skin (P less than 0.05). Changes in skin blood flow and temperature after local heating and cooling of the skin were similar at all sites assessed and were not associated with significant changes in reflectance spectrophotometry, the parameter which correlated most closely with skin colour.     

Reduced vasoactive responses in port wine stains

Changes in skin blood flow and haemoglobin content of port wine stains and clinically normal contralateral skin were determined by laser-Doppler flowmetry and reflectance spectrophotometry in 14 patients after application of a vasodilating cream containing methyl nicotinate 1.0%, glycol salicylate 10.0% and capsaicin BPC 0.1% (Algipan cream) and in 16 patients after application of a corticosteroid tape containing flurandrenolone (Haelan tape). Changes in blood flow measured after application of vasodilator cream were significantly reduced in port wine stains compared with contralateral skin (P less than 0.01). After application of the vasoconstrictor steroid tape changes in blood flow were significantly reduced in the port wine stains (P less than 0.05) and changes in haemoglobin content were also significantly reduced in the port wine stains compared with normal skin (P less than 0.05). These results support the concept of reduced autonomic innervation of cutaneous vasculature in port wine stains.     

Treatment of naevi flammei with the argon laser

We report on 901 patients with port wine stains treated by means of an argon laser. The treatment results have been definitively evaluated in 371 patients. They were significantly influenced by the patients' age and by the colour of the lesions. The worst response to the therapy was seen in pink port wine stains in children and juvenile patients (20% good results), in contrast to red and purple lesions in adult patients (80% excellent and good results). The size of the port wine stains did not significantly influence the treatment results, but in extensive lesions homogeneous lightening could not usually be attained and treatment often extended over some years. Port wine stains in the head and neck area responded best to therapy, and lesions on the legs, worst. Altogether, in 60%-70% of adult patients excellent or good results were obtained, the lesions being completely removed or significantly lightened and reduced in size. The side-effects of laser therapy were scar formation (7.3%) and changes in pigmentation (8.6%).     

Pulsed dye laser (577 nm) treatment of portwine stains: ultrastructural evidence of neovascularization and mast cell degranulation in healed lesions

Portwine stains were examined before, immediately after, and 1 yr after successful clearance by a pulsed dye laser (577 nm) using ultrastructural techniques. Dilated vascular channels and mast cell hypoplasia characterized lesional skin before treatment. Immediately after treatment, widespread selective vessel necrosis, similar to changes previously described, was observed. One year after laser irradiation, the abnormally ectatic portwine stain vessels had been replaced by small venules and arterioles, similar in number and diameter to blood vessels in normal skin; the only difference noted was that these new vessels were surrounded by easily identifiable mast cells. Many of these mast cells exhibited evidence of activation and degranulation. We conclude that mast cells may play an important role in the neovascularization of portwine stains treated by 577-nm dye laser irradiation.     

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。     

Acquired port wine stains:clinical and psychological assessment and response to pulsed dye laser therapy

Nineteen patients are presented with acquired port wine stains. Acquired port wine stains are uncommon vascular lesions with the appearance of a congenital port wine stain but onset after birth. This is the largest group of patients reported to date. The acquired port wine stain was on the head and neck in 17 patients and in six this was associated with preceding trauma. Psychological assessments in adult patients showed similar morbidity to that seen in patients with congenital port wine stains. This morbidity was improved with successful laser treatment. Pulsed dye laser therapy resulted in complete clearance of the lesion in six (46%) of 13 patients treated. Two further patients had an excellent response.     

Laser treatment of pediatric vascular lesions: Port wine stains and hemangiomas

Pediatric vascular lesions can be medically threatening and psychologically distressing to patients. This article reviews literature on the laser treatment of two common pediatric vascular lesions, port wine stains and hemangiomas. The purpose of this report was to distinguish the lesions from one another and to present the advantages, disadvantages, complications, and limitations of laser treatment for each lesion type. This review is not a comprehensive inventory but instead highlights the studies that best show promising results or the limitations of laser treatment for the lesions. Overall, port wine stain laser treatment promoted notable clearing with low side effects, whereas hemangioma laser treatment provided inconsistent benefits and severe side effects occasionally. Laser treatment of port wine stains is safe and effective, but laser treatment of hemangiomas remains controversial and is best for lesions without deeper components.     

Immunofluorescent staining with antibodies to factor VIII, fibronectin, and collagenous basement membrane protein in normal human skin and port wine stains

Specific antibodies directed against three important components of the vessel wall (collagenous basement membrane protein-type IV collagen, fibronectin, and factor VIII) were used to study and compare the distribution of these proteins in normal skin and port wine stains. Collagenous basement membrane protein was localized to the basement membrane and basal lamina zones of blood vessels, appendages, arrector pili muscles, endoneurium and perineurium, and the dermoepidermal junction of both port wine stains and normal skin. Vessels of the port wine stain as well as those of normal skin showed a similar narrow uniform homogeneous line of fluorescence. Granular endothelial staining was seen in the blood vessels of both normal skin and port wine stains. The distribution of fibronectin was that of a low-intensity punctate pattern situated in the subendothelial region of both port wine stain and normal vessels and in the basement membrane zones of hair follicles, endoneurium and perineurium, and the dermoepidermal junction.     

(5) Objective assessments of portwine stains

With advances in the treatment of portwine stains (PWS), it is important to develop more objective assessments than clinical observation to assist in predicting the outcome of therapy and quantification of results and in understanding the pathophysiology of PWS.
Three variables have been measured in a temperature-controlled environment: redness as a measure of haemoglobin content using a reflectance spectrophotometer,¹ blood flow using laser doppler flowmetry and skin temperature using a thermocouple, in 11 patients with facial PWS (8 male, 3 female, mean age 29·8 years), in the normal contralateral skin and in the facial skin of five healthy volunteers (3 male, 2 female, mean age 29·6 years). Results are shown in Table 1 .  

  TABLE 1     

10.

Die Behandlung von Feuermalen mit dem blitzlampengepumpten gepulsten Farbstofflaser Ergebnisse aus 5 Jahren klinischer Erfahrung     

M. B. Wimmershoff  M. Wenig  U. Hohenleutner  M. Landthaler 《Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete》2001,52(11):1011-1015

BACKGROUND AND OBJECTIVE: Portwine stains are reported to occur in 2.8% of the newborn. Depending on the location and size, portwine stains can be disfiguring and may lead to psychosocial complications. They can be safely and successfully treated with the flashlamp pumped pulsed dye laser (FPDL). Our objective was to evaluate retrospectively the efficacy of the FPDL (450 microseconds, 585 nm, 5 and 7 mm) after five years of clinical experience with this laser. PATIENTS/METHODS: Between 1993-1998 in 961 patients with port-wine stains laser treatment was performed in the department of dermatology of the university of Regensburg. RESULTS: Total clearance of the portwine stain was recorded in 6.9% of the patients. In 40.4% of the patients 75-95% clearance and in 38.5% 50-75% clearance was observed. In 14.2% response was less than 50%. Laser therapy was more effective for lesions of the neck and trunk than for lesions on the head and extremities. Better results were found after laser therapy of light-red or red portwine stains compared to dark red and violaceus portwine stains. In children (less than 3 year old), clearance of more than 75% occurred significantly more often than in older patients. CONCLUSIONS: Since laser treatment in early childhood is more effective than treatment at a later age, a smaller number of treatment sessions is necessary and lower recurrence rates can be expected, laser treatment should be started in early childhood. Side effects were rare after FPDL treatment. This study underlines that the FPDL is a safe and successful treatment for portwine stains with rare side effects. But total clearance can only be reached in a small number of patients.     

11.

Copper vapour laser treatment of port-wine stains in brown skin     

Jin Ho Chung  Woo Seok Koh  Dong Youn Lee  Young Suk Lee  Hee Chul Eun  Jai Il Youn 《The Australasian journal of dermatology》1997,38(1):15-21

Forty-seven Korean patients with port-wine stains were treated with a copper vapour laser and clinical responses were assessed at three months after the last treatment by comparing photographs taken before each treatment The immediate histologic changes within 15min after laser treatment were also observed by routine H & E and nitroblue tetrazolium chloride staining. When we treated port-wine stains with minimal whitening doses of 6-8 J/cm², no or slight colour changes were obtained. Thus, all port-wine stain lesions in this study were treated with non-specific energy densities ranging from 10-20 J/cm². Good to excellent results were obtained in 18 (38.2%) of 47 Korean patients with port-wine stains. Repeated treatment can continue to reduce colour. Darker lesions (purple or red) are more likely to result in a marked colour change. At above threshold dose, there was wedge-shaped diffuse coagulation necrosis and loss of viability of the epidermis and underlying dermis. Even though copper vapour laser treatment of port-wine stains in brown skin is not as selective as in white skin because of epidermal melanin, our clinical data demonstrate the usefulness of the copper vapour laser for the treatment of port-wine stains in brown skin.     

12.

Are port wines stains a feature of tuberous sclerosis?     

D. Ben‐Amitai  S. Halachmi  M. Lapidoth 《Journal of the European Academy of Dermatology and Venereology》2011,25(7):804-807

Background Tuberous sclerosis complex is a multisystem inherited disorder characterized by the development of tumour‐like growths in brain, skin and other organs. Although cutaneous vascular anomalies are not considered a common manifestation, we have encountered co‐occurrence of port wine stains and tuberous sclerosis. Objective To assess the prevalence of port wine stain in patients with previously diagnosed tuberous sclerosis. Methods All cases diagnosed with tuberous sclerosis at two tertiary care centres from 2000 to 2009 were reviewed. Cases with clinically documented port wine stains were included for evaluation. Results Of 24 patients diagnosed with tuberous sclerosis, three (12.5%) had clinically evident port wine stains. The prevalence of port wine stains in this series of tuberous sclerosis patients was significantly higher than the 0.3% prevalence of port wine stain in the general population. Conclusion Port wine stain rate in this population was significantly greater than the expected rate. Further studies are needed to assess the frequency of port wine stains in tuberous sclerosis and to clarify whether the finding should be added to the list of cutaneous features of tuberous sclerosis.     

13.

脉冲染料激光治疗鲜红斑痣的临床疗效分析   总被引：13，自引：2，他引：11  

谭志建  童晓荣  刘凌  万兴祥 《临床皮肤科杂志》2001,30(1):27-29

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。     

14.

Five years' experience of treating port wine stains with the flashlamp-pumped pulsed dye laser   总被引：1，自引：0，他引：1  

G.A. KATUGAMPOLA  S.W. LANIGAN 《The British journal of dermatology》1997,137(5):750-754

Summary During the last 5 years, 640 patients had treatment to their port wine stains (PWS) with a flashlamp-pumped pulsed dye laser. One hundred and fifty-six patients have been discharged for varying reasons, of which 59 (38%) achieved excellent (at least 75%) lightening of their birthmark. Of the remaining patients, those who attended the clinic for the sixth and 12th time for treatment were also assessed to determine the degree of fading achieved in the port wine stain. Our findings confirm that flashlamp-pumped dye laser treatment is safe and effective for the treatment of PWS and that complications are rare. However, the degree of fading achieved is variable and often unpredictable. Fifty-two per cent of facial lesions of different colours achieved over 75% fading as against 18% of non-facial lesions. Sixty-four per cent of those over the age of 50 years had an excellent response whereas only 19% of those below the age of 5 years were able to achieve a similar result. The colour of the port wine stain was found to be of no prognostic value. A search for an accurate and non-invasive method to predict the outcome of flashlamp-pumped pulsed dye laser therapy for PWS is warranted.     

15.

Histology of port wine stains after copper vapour laser treatment     

E.P. WALKER  P.H. BUTLER  J.W. PICKERING  W.A. DAY  R. FRASER  C.N. VAN  HALEWYN 《The British journal of dermatology》1989,121(2):217-223

We report histological changes in four patients with port wine stains treated with 578 nm yellow light from a high power copper vapour laser. Histology showed that selective damage occurred to the ectatic blood-vessels in the dermis, without haemorrhage and damage to non-vascular structures, and without scarring. The initial damage to the overlying epidermis was not permanent, and the damaged ectatic vessels returned to normal size or were completely necrosed and replaced by collagen.     

16.

色度值评价光动力治疗鲜红斑痣的疗效     

苑凯华  高建华  李勤  余文林  曾东  夏丽娟  翁伟丽 《中华皮肤科杂志》2010,43(10):730-731

目的：通过色度值检测,客观评价鲜红痣光动力治疗的疗效。方法 选择浅紫型颞部和面颊部鲜红斑痣患者共72例,用光谱光度测色仪测量治疗前后鲜红斑痣与对侧正常皮肤的色度值,计算病变区与对侧正常皮肤的色差及治疗后退色的百分比,进行疗效分级,并做统计学处理。结果 颞部鲜红斑痣病变的疗效：优秀26.19%,良好33.33%,一般23.80%,差11.90%,无反应4.76,面颊部鲜红斑痣的疗效为优秀：6.67%,良好：16.67%,一般：33.33%,差：26.67%,无反应：16.67%,两者疗效的差异的统计学意义。结论 色度值能客观、准确、定量评估鲜红斑痣的疗效,颞部鲜红斑痣光动力治疗的疗效优于面颊部。     

17.

Variable pulse frequency-doubled Nd:YAG laser versus flashlamp-pumped pulsed dye laser in the treatment of port wine stains     

Lorenz S  Scherer K  Wimmershoff MB  Landthaler M  Hohenleutner U 《Acta dermato-venereologica》2003,83(3):210-213

The flashlamp-pumped pulsed dye laser (FPDL) is regarded as the gold standard in the treatment of port wine stains. The purpose of this prospective, intra-individual, comparative clinical study was to investigate whether a frequency-doubled variable pulsed Nd:YAG laser (frequency-doubled Nd:YAG) is equally as safe and effective as established lasers. Forty-three patients with port wine stains were included in the study. Test treatments were performed using the frequency-doubled Nd:YAG laser (532 nm; 4 mm psi; 5-50 ms; 5.5 to 15 J/cm2) versus the FPDL (585 nm; 450 micros; 7 mm psi; 6 J/cm2). After 6 weeks, a full lesional treatment was performed using the device and the parameters showing the best clearance and the fewest side effects. The clearance of the lesions was generally good to fair. With the exception of poor results at 5 ms and 5.5 J/cm2 with the frequency-doubled Nd:YAG laser, there were no significant differences between the two laser devices. Scar formation, nevertheless, occurred in only 3% of the FPDL-treated sites versus up to 18% of the frequency-doubled Nd:YAG sites, increasing with pulse duration. In port wine stains, the FPDL remains the therapy of choice because of the somewhat better results and a lower frequency of side effects, especially scarring.     

18.

Der Nd:YAG-Laser im Wandel der (Impuls-) Zeiten – Einsatzgebiete in der Dermatologie     

Greve B  Raulin C 《Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete》2000,51(3):152-158

The neodymium:yttrium-aluminium-garnet-(Nd:YAG) laser is one of the most versatile and interesting lasers in dermatological laser medicine. Almost no other laser has such a wide spectrum of applications. Depending on wave length (1064 nm, frequency-doubled 532 nm) and mode (continuous, Q-switched, long-pulsed), benign pigmented lesions (tattoos, traumatic tattoos, naevus of Ota, cafe-au-lait-macules, lentigines) and vascular lesions (hemangiomas, portwine stains, essential teleangiectasias, angiomas) can be treated. Additionally this laser has been occasionally used to remove Kaposi sarcomas and epithelial skin tumors.     

19.

Evaluation of port wine stain perfusion by laser Doppler imaging and thermography before and after argon laser treatment.     

A Troilius  K W?rdell  S Bornmyr  G E Nilsson  B Ljunggren 《Acta dermato-venereologica》1992,72(1):6-10

Thirteen patients with port wine stains (PWS) were treated with argon laser therapy. Before and at different points in time following treatment, skin blood perfusion and temperature were mapped with laser Doppler imaging and thermography. In nine patients no elevation in blood perfusion was observed in the PWS in comparison with the surrounding normal skin before treatment. In the remaining four patients a significantly (p less than 0.01) higher blood flow was recorded within the PWS. Immediately after treatment nine patients showed elevated perfusion within the PWS. During the first two days following treatment, all patients showed a gradually decreasing hyperperfusion in the borderline between the PWS lesion and surrounding skin. Immediately after treatment 10 patients had a significantly (p less than 0.01) higher temperature in the PWS than in normal skin. During the first 24 h following treatment, an elevated perfusion was in general accompanied by a tissue temperature increase. Three and a half months after argon laser treatment, three patients showed excellent clinical results with no remaining PWS spots or scarring. Two of these patients had had both elevated perfusion and temperature in the PWS prior to treatment.     

20.

Hautveränderungen bei Neugeborenen in den ersten 5 Lebenstagen     

Lorenz S  Maier C  Segerer H  Landthaler M  Hohenleutner U 《Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete》2000,51(6):396-400

Background and Objective. To prospectively survey skin lesions in a large group of newborns, as no such study has as yet been performed in Germany. Patients/Methods. In a prospective study, we examined one thousand newborn babies twelve to 120 hours old. Results. In 59.7%, one or more skin lesions could be detected, some of which were only transient. Noticeable differences from other studies included a higher incidence of congenital melanocytic nevi (6%) and port wine stains (2,8%). lnstead of the usual male:female ratio of 1:2 we found a 1:1 ratio for port wine stains. Toxic erythema of the newborn and milia were less frequent than in other studies. Conclusions. With a frequency of 37.2%, vascular lesions such as nevus flammeus and hemangioma are the most common skin lesions in newborns. Our study found a higher incidence of congenital melanocytic nevi than reported in literature. An associated of skin lesions and maternal smoking during pregnancy was not detected.     

Die Behandlung von Feuermalen mit dem blitzlampengepumpten gepulsten Farbstofflaser Ergebnisse aus 5 Jahren klinischer Erfahrung

BACKGROUND AND OBJECTIVE: Portwine stains are reported to occur in 2.8% of the newborn. Depending on the location and size, portwine stains can be disfiguring and may lead to psychosocial complications. They can be safely and successfully treated with the flashlamp pumped pulsed dye laser (FPDL). Our objective was to evaluate retrospectively the efficacy of the FPDL (450 microseconds, 585 nm, 5 and 7 mm) after five years of clinical experience with this laser. PATIENTS/METHODS: Between 1993-1998 in 961 patients with port-wine stains laser treatment was performed in the department of dermatology of the university of Regensburg. RESULTS: Total clearance of the portwine stain was recorded in 6.9% of the patients. In 40.4% of the patients 75-95% clearance and in 38.5% 50-75% clearance was observed. In 14.2% response was less than 50%. Laser therapy was more effective for lesions of the neck and trunk than for lesions on the head and extremities. Better results were found after laser therapy of light-red or red portwine stains compared to dark red and violaceus portwine stains. In children (less than 3 year old), clearance of more than 75% occurred significantly more often than in older patients. CONCLUSIONS: Since laser treatment in early childhood is more effective than treatment at a later age, a smaller number of treatment sessions is necessary and lower recurrence rates can be expected, laser treatment should be started in early childhood. Side effects were rare after FPDL treatment. This study underlines that the FPDL is a safe and successful treatment for portwine stains with rare side effects. But total clearance can only be reached in a small number of patients.     

Copper vapour laser treatment of port-wine stains in brown skin

Forty-seven Korean patients with port-wine stains were treated with a copper vapour laser and clinical responses were assessed at three months after the last treatment by comparing photographs taken before each treatment The immediate histologic changes within 15min after laser treatment were also observed by routine H & E and nitroblue tetrazolium chloride staining. When we treated port-wine stains with minimal whitening doses of 6-8 J/cm², no or slight colour changes were obtained. Thus, all port-wine stain lesions in this study were treated with non-specific energy densities ranging from 10-20 J/cm². Good to excellent results were obtained in 18 (38.2%) of 47 Korean patients with port-wine stains. Repeated treatment can continue to reduce colour. Darker lesions (purple or red) are more likely to result in a marked colour change. At above threshold dose, there was wedge-shaped diffuse coagulation necrosis and loss of viability of the epidermis and underlying dermis. Even though copper vapour laser treatment of port-wine stains in brown skin is not as selective as in white skin because of epidermal melanin, our clinical data demonstrate the usefulness of the copper vapour laser for the treatment of port-wine stains in brown skin.     

Are port wines stains a feature of tuberous sclerosis?

Background Tuberous sclerosis complex is a multisystem inherited disorder characterized by the development of tumour‐like growths in brain, skin and other organs. Although cutaneous vascular anomalies are not considered a common manifestation, we have encountered co‐occurrence of port wine stains and tuberous sclerosis. Objective To assess the prevalence of port wine stain in patients with previously diagnosed tuberous sclerosis. Methods All cases diagnosed with tuberous sclerosis at two tertiary care centres from 2000 to 2009 were reviewed. Cases with clinically documented port wine stains were included for evaluation. Results Of 24 patients diagnosed with tuberous sclerosis, three (12.5%) had clinically evident port wine stains. The prevalence of port wine stains in this series of tuberous sclerosis patients was significantly higher than the 0.3% prevalence of port wine stain in the general population. Conclusion Port wine stain rate in this population was significantly greater than the expected rate. Further studies are needed to assess the frequency of port wine stains in tuberous sclerosis and to clarify whether the finding should be added to the list of cutaneous features of tuberous sclerosis.     

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。     

Five years' experience of treating port wine stains with the flashlamp-pumped pulsed dye laser

Summary During the last 5 years, 640 patients had treatment to their port wine stains (PWS) with a flashlamp-pumped pulsed dye laser. One hundred and fifty-six patients have been discharged for varying reasons, of which 59 (38%) achieved excellent (at least 75%) lightening of their birthmark. Of the remaining patients, those who attended the clinic for the sixth and 12th time for treatment were also assessed to determine the degree of fading achieved in the port wine stain. Our findings confirm that flashlamp-pumped dye laser treatment is safe and effective for the treatment of PWS and that complications are rare. However, the degree of fading achieved is variable and often unpredictable. Fifty-two per cent of facial lesions of different colours achieved over 75% fading as against 18% of non-facial lesions. Sixty-four per cent of those over the age of 50 years had an excellent response whereas only 19% of those below the age of 5 years were able to achieve a similar result. The colour of the port wine stain was found to be of no prognostic value. A search for an accurate and non-invasive method to predict the outcome of flashlamp-pumped pulsed dye laser therapy for PWS is warranted.     

Histology of port wine stains after copper vapour laser treatment

We report histological changes in four patients with port wine stains treated with 578 nm yellow light from a high power copper vapour laser. Histology showed that selective damage occurred to the ectatic blood-vessels in the dermis, without haemorrhage and damage to non-vascular structures, and without scarring. The initial damage to the overlying epidermis was not permanent, and the damaged ectatic vessels returned to normal size or were completely necrosed and replaced by collagen.     

色度值评价光动力治疗鲜红斑痣的疗效

目的：通过色度值检测,客观评价鲜红痣光动力治疗的疗效。方法 选择浅紫型颞部和面颊部鲜红斑痣患者共72例,用光谱光度测色仪测量治疗前后鲜红斑痣与对侧正常皮肤的色度值,计算病变区与对侧正常皮肤的色差及治疗后退色的百分比,进行疗效分级,并做统计学处理。结果 颞部鲜红斑痣病变的疗效：优秀26.19%,良好33.33%,一般23.80%,差11.90%,无反应4.76,面颊部鲜红斑痣的疗效为优秀：6.67%,良好：16.67%,一般：33.33%,差：26.67%,无反应：16.67%,两者疗效的差异的统计学意义。结论 色度值能客观、准确、定量评估鲜红斑痣的疗效,颞部鲜红斑痣光动力治疗的疗效优于面颊部。     

Variable pulse frequency-doubled Nd:YAG laser versus flashlamp-pumped pulsed dye laser in the treatment of port wine stains

The flashlamp-pumped pulsed dye laser (FPDL) is regarded as the gold standard in the treatment of port wine stains. The purpose of this prospective, intra-individual, comparative clinical study was to investigate whether a frequency-doubled variable pulsed Nd:YAG laser (frequency-doubled Nd:YAG) is equally as safe and effective as established lasers. Forty-three patients with port wine stains were included in the study. Test treatments were performed using the frequency-doubled Nd:YAG laser (532 nm; 4 mm psi; 5-50 ms; 5.5 to 15 J/cm2) versus the FPDL (585 nm; 450 micros; 7 mm psi; 6 J/cm2). After 6 weeks, a full lesional treatment was performed using the device and the parameters showing the best clearance and the fewest side effects. The clearance of the lesions was generally good to fair. With the exception of poor results at 5 ms and 5.5 J/cm2 with the frequency-doubled Nd:YAG laser, there were no significant differences between the two laser devices. Scar formation, nevertheless, occurred in only 3% of the FPDL-treated sites versus up to 18% of the frequency-doubled Nd:YAG sites, increasing with pulse duration. In port wine stains, the FPDL remains the therapy of choice because of the somewhat better results and a lower frequency of side effects, especially scarring.     

Der Nd:YAG-Laser im Wandel der (Impuls-) Zeiten – Einsatzgebiete in der Dermatologie

The neodymium:yttrium-aluminium-garnet-(Nd:YAG) laser is one of the most versatile and interesting lasers in dermatological laser medicine. Almost no other laser has such a wide spectrum of applications. Depending on wave length (1064 nm, frequency-doubled 532 nm) and mode (continuous, Q-switched, long-pulsed), benign pigmented lesions (tattoos, traumatic tattoos, naevus of Ota, cafe-au-lait-macules, lentigines) and vascular lesions (hemangiomas, portwine stains, essential teleangiectasias, angiomas) can be treated. Additionally this laser has been occasionally used to remove Kaposi sarcomas and epithelial skin tumors.     

Evaluation of port wine stain perfusion by laser Doppler imaging and thermography before and after argon laser treatment.

Thirteen patients with port wine stains (PWS) were treated with argon laser therapy. Before and at different points in time following treatment, skin blood perfusion and temperature were mapped with laser Doppler imaging and thermography. In nine patients no elevation in blood perfusion was observed in the PWS in comparison with the surrounding normal skin before treatment. In the remaining four patients a significantly (p less than 0.01) higher blood flow was recorded within the PWS. Immediately after treatment nine patients showed elevated perfusion within the PWS. During the first two days following treatment, all patients showed a gradually decreasing hyperperfusion in the borderline between the PWS lesion and surrounding skin. Immediately after treatment 10 patients had a significantly (p less than 0.01) higher temperature in the PWS than in normal skin. During the first 24 h following treatment, an elevated perfusion was in general accompanied by a tissue temperature increase. Three and a half months after argon laser treatment, three patients showed excellent clinical results with no remaining PWS spots or scarring. Two of these patients had had both elevated perfusion and temperature in the PWS prior to treatment.     

Hautveränderungen bei Neugeborenen in den ersten 5 Lebenstagen

Background and Objective. To prospectively survey skin lesions in a large group of newborns, as no such study has as yet been performed in Germany. Patients/Methods. In a prospective study, we examined one thousand newborn babies twelve to 120 hours old. Results. In 59.7%, one or more skin lesions could be detected, some of which were only transient. Noticeable differences from other studies included a higher incidence of congenital melanocytic nevi (6%) and port wine stains (2,8%). lnstead of the usual male:female ratio of 1:2 we found a 1:1 ratio for port wine stains. Toxic erythema of the newborn and milia were less frequent than in other studies. Conclusions. With a frequency of 37.2%, vascular lesions such as nevus flammeus and hemangioma are the most common skin lesions in newborns. Our study found a higher incidence of congenital melanocytic nevi than reported in literature. An associated of skin lesions and maternal smoking during pregnancy was not detected.