Tianyou Wang

Prospective comparison treatment of 595-nm pulsed-dye lasers for virgin port-wine stain

Vbeam® and Cynergy® are 595‐nm pulsed‐dye laser (PDL) equipment options, both extensively used in the clinical treatment of port‐wine stains (PWS). However, there has been no study conducted of the differences in PWS therapeutic outcomes across both devices.

Is Propranolol Safe and Effective for Outpatient Use for Infantile Hemangioma? A Prospective Study of 679 Cases From One Center in China.

Background The protocol for the treatment of infantile hemangioma with propranolol varies among different clinical centers. Methods Six hundred seventy-nine patients who were 1 to 12 months old were recruited in this prospective study to receive propranolol treatment. The response to the propranolol therapy was classified as 4 levels. The results were primarily evaluated using color Doppler ultrasound examinations before and after propranolol treatment. Results The response was excellent in 176 (25.9%), good in 492 (72.5%), stable in 5 (0.7%), and poor in 6 (0.9%) of the patients. The mean age at the initiation of the therapy was 3.3 months (range, 1 to 10.9 months) and the mean duration of the therapy was 7.1 months (range, 3–17 months). The mean duration of the follow-up time after the discontinuation of the therapy was 5.3 months (range, 3–17 months). Regrowth of the hemangioma was observed in 92 cases (13.5%). Seventy-nine (11.6%) of the parents complained of their child’s minor discomfort during the therapy. Conclusions Propranolol (2 mg/kg per day) may significantly reduce the size of a hemangioma. As an outpatient therapy, propranolol was found to be safe for Chinese children and to have minor side effects.

Management of periorbital microcystic lymphatic malformation with blepharoptosis: Surgical treatment combined with intralesional bleomycin injection

OBJECTIVES Periorbital microcystic lymphatic malformations (LM) can cause severe symptoms, such as blepharoptosis, amblyopia, chemosis, strabismus, diminished vision, and blindness. The purpose of this study was to evaluate the clinical outcome in periorbital microcystic LM patients with blepharoptosis who underwent surgical treatment combined with intralesional bleomycin injection. PATIENTS AND METHODS A retrospective study including nine patients diagnosed as periorbital microcystic LM with blepharoptosis was conducted. All of the patients underwent surgical treatment and bleomycin injection from January 2010 to January 2014. The lesion was resected through the lower eyebrow and/or a coronal incision at the first stage, and levator resection was performed at the second stage. Any persistent lesion or its recurrence was managed by intralesional bleomycin injection. RESULTS Blepharoptosis and visual obstruction were corrected in all patients. Mean follow-up was 24.6 months. Six patients had recurrence during the follow-up, and two patients who had partial eyelid closure after the second stage surgery recovered in three months. Amblyopia, astigmatism, and strabismus were not improved after treatment. All of the patients had excellent aesthetic improvement and corrected blepharoptosis. CONCLUSIONS Resection through a lower eyebrow and coronal incision and levator resection performed in two stages can quickly correct the visual impairment caused by periorbital microcystic lymphatic malformation with blepharoptosis. Intralesional bleomycin injection is a promising adjunctive therapy for residual or recurrent lesions after surgery.

A prospective self-controlled study of topical timolol 0.5% cream for large superficial infantile hemangiomas

Timolol has recently been reported to be an effective and safe treatment for small and superficial infantile hemangiomas (IH). However, it is controversial to choose it as an alternative to oral propranolol for large superficial IH. In this study, we generated a new modified timolol agent as the base of an ointment. To evaluate the efficacy and safety of this new agent, we recruited 20 patients with large superficial IH. The average age was 4 months old. The average area of the IH was 28.8 cm2. The treatment was continued for 2–6 months. Three assessors were asked to judge the changes in both the treated and untreated parts separately by comparing photographs. After an average of 3.25 months of treatment, the average visual analog scale scores were 5.5 and 4.3 for those with and without the medication, respectively. The treated parts regressed significantly more than the untreated parts (P < 0.05). There were no side‐effects observed during treatment. High performance liquid chromatography was used to detect the serum concentration of timolol, and no timolol was detected in any of the blood samples (<0.02 μg/mL). Our new modified timolol agent is proven to be an effective therapy option for IH. Prospective studies with high‐precision serum timolol concentrations, with heart rate or blood pressure monitoring during treatment, are needed to evaluate potential systemic absorption when using timolol on large IH.

Treatment of Early-stage Extracranial Arteriovenous Malformations with Intralesional Interstitial Bleomycin Injection: A Pilot Study

Purpose To assess the efficacy and safety of intralesional interstitial bleomycin injection in the treatment of early-stage (Schobinger stage I or II) extracranial arteriovenous malformations (AVMs). Materials and Methods This prospective study involved 34 patients with early-stage AVMs, as defined by the Schobinger staging system. The patients received intralesional interstitial bleomycin injected at a maximum dose of 15 000 IU or 1000 IU per kilogram of body weight for children who weighed less than 15 kg per procedure for a total of 6 months (once every month). Therapeutic outcome was evaluated by the degree of devascularization at angiography and the clinical outcome 3 months after the last treatment. Further follow-up was evaluated based on further clinical outcome. Adverse events were recorded according to the Society of Interventional Radiology classification. Results Of the 34 patients with early-stage AVM, 32 (mean age, 20.5 years; 24 female [75%]) completed the study. The results showed that 27 (84.4%, 95% confidence interval [CI]: 71.1, 97.7) patients were responsive to bleomycin injection, including nine (28.1%) with a complete response. Four (12.5%) patients showed no response, and one (3.1%) patient experienced worsening 3 months after the last treatment. During further follow-up (mean follow-up time, 20.7 months; range, 5-28 months), the outcome remained stable in 31 (96.9%) of the 32 patients. A major complication, anaphylactic shock, was observed in one (3.1%, 95% CI: 0, 9.5) patient. Common minor complications included hyperpigmentation, nausea, pruritus, and bullae. Conclusion Intralesional interstitial bleomycin injection is a feasible approach for early-stage AVMs and yields safe and effective outcomes.

Ethanol Embolotherapy for the Management of Refractory Chronic Skin Ulcers Caused by Arteriovenous Malformations

PURPOSE To describe the clinical features and treatment outcomes of ethanol embolotherapy in refractory chronic skin ulcers caused by arteriovenous malformations (AVMs). MATERIALS AND METHODS From October 2011 to October 2015, 12 patients (5 male; mean age, 26.2 y) with refractory chronic skin ulcers caused by AVMs were treated at a single institution. Ethanol embolotherapy was performed by direct puncture techniques. Needles were directly inserted toward the nidus of the lesion based on imaging analysis. When fast blood reflux was noted, angiography was performed to ensure only the nidus and draining vein were opacified. Symptoms before and after treatment, previous treatment of AVMs and ulcers, embolotherapy sessions, follow-up time, complications, and degree of devascularization were recorded. Treatment outcomes were established by evaluating symptom outcomes and the degree of devascularization on follow-up angiography. RESULTS Fifty embolotherapy procedures were performed in 12 patients: 6 underwent procedures on the head and neck, 4 on the feet, and 2 on the hands. Four patients (33.3%) experienced complete resolution of abnormal angioarchitecture according to follow-up angiography. Complete control of ulcers was achieved in all 12 patients. Two procedures (4%) in 2 patients (16.7%) caused superficial skin necrosis that healed spontaneously within 4 weeks. Thirteen procedures (26%) in 9 patients (75%) caused blistering immediately after treatment. There were no major complications. CONCLUSIONS In a limited series, ethanol embolotherapy was effective and safe in the treatment of refractory chronic skin ulcers caused by AVMs.

Safety and Efficacy of Dual Wavelength Laser (1064 nm + 595 nm) for Treatment of Non-treated Port-Wine Stains

Patients with port‐wine stain (PWS) suffer physically and psychologically because of the high incidence (0.3%–0.5%) of the disease. Pulsed‐dye laser (PDL) at 595 nm is the gold standard of the treatment for PWS. Nevertheless, clinicians intend to determine whether the dual‐wavelength laser (DWL; 595‐nm PDL + 1064‐nm Nd:YAG) is an adequate choice in the treatment of non‐treated PWS. This study is the first prospective within‐patient controlled research seeking to investigate the safety and efficacy of DWL for the treatment of non‐treated PWS.

Randomized split-face, controlled comparison of treatment with 1565-nm nonablative fractional laser for enlarged facial pores

DEAR EDITOR, Enlarged pores are a common cosmetic concern. Although nonablative fractional lasers (NAFLs) have been used to reduce enlarged facial pores, a prospective, split-face, controlled study with objective assessment is lacking. A 1565-nm NAFL (M22 ResurFX; Lumenis, Yokneam, Israel) has proved effective on skin elasticity and stretch marks; therefore, we aimed to assess its safety and efficacy on enlarged facial pores. The present study was approved by the investigational review board of the Shanghai Ninth People’s Hospital (clinical trials registration number ChiCTR-ONh-16009094). We initially estimated an improvement of 40% on the treated side of the face vs. the nontreated side. To estimate sample size, we tested the null hypothesis that there would be a decrease of ≤ 10% in the number of enlarged pores between both sides of the face. With a sample size of 17, a 40% difference between the two sides would refute this hypothesis with a power of 80% and a 2 5% level of significance. In total, 22 participants with increased seborrhoea and enlarged pores were enrolled. Seventeen patients completed the study and five dropped out. Complaints of pain or oedema and personal reasons accounted for the dropouts. Based on a computer-generated randomization list, one side of the face was treated and the other side served as the control (Fig. 1a; further images are available from the corresponding author upon request). EMLA (Astra Pharmaceuticals, Oslo, Norway), a topical anaesthetic ointment (containing 25 mg lidocaine and 25 mg prilocaine), was applied 1 h before treatment. Spots measuring 17 mm with integrated contact cooling were used. A 38–40 mJ per microbeam laser was used for the first pass and 20–24 mJ per microbeam for the second; density was 300 microbeams per cm for both passes. The same parameters were used for a total of four treatments carried out at 2-week intervals. The quantitative number of pores was automatically calculated with the VISIA-CR imaging system (Canfield Scientific, Fairfield, NJ, U.S.A.) before treatment and 2 months after the final treatment. The device detects pores using an algorithm designed to detect circular objects of 0 4–1 0 mm in diameter. Feature analysis only occurs within automatically targeted zonal mask regions representing the best view, thereby reducing variability due to the camera angle. Use of the NAFL significantly decreased the number of facial pores (P < 0.001) post-treatment. The total average number of facial pores was 1015 on the NAFL-treated side and 1012 on the untreated side; these numbers decreased to 631 and 848, respectively, at the 2-month follow-up. The average pore reduction rate was 41 1% for the NAFL side and 16 5% for the untreated side (Fig. 1b–f). Missing data were not included. Participants were asked to rate the degree of pain immediately post-treatment using a visual analogue scale (VAS) ranging from 0 (no pain at all) to 10 (unbearable pain). Pain was reported as mild to moderate with a mean SD VAS score of 4 75 1 23. Other adverse events included immediate slightto-moderate erythema and oedema (100%), which continued for 2–4 days post-treatment. No permanent side-effects were seen. Compared with traditional ablative procedures, such as the CO2 fractional laser or the erbium–yttrium aluminum garnet fractional laser, NAFL allows for quicker healing with minimal downtime, low treatment discomfort and relatively fewer side-effects. Enlarged pores have been treated with an increasing focus on increased seborrhoea rather than as a component of photoageing. Only mild improvement of facial pores has been observed using a 1064-nm neodymium-doped yttrium aluminum garnet laser. Recently, NAFLs were introduced for skin resurfacing. Compared with the 1550/1540-nm laser, the 1565-nm NAFL has similar water absorption features. However, the newest CoolScan technique, as well as its integrated contact cooling system, has limited the bulk heating to the dermis, making it safer for sensitive or darker skin than other NAFLs. The ‘bystander effect’ may have contributed to the decrease of pores on the untreated side of the face. In the absence of any direct heating, heat diffusion or cell-to-cell contact, ‘bystander’ cells experience DNA damage, apoptosis and loss of viability when sharing the medium with heat-exposed cells. This is mostly found in dividing cells. We hypothesize that both bystander effects and an improvement in patient lifestyle contributed to skin resurfacing on the untreated sides of the face. The present study is the first split-face controlled trial using a 1565-nm NAFL with objective measurements for treating facial pores. Limitations include the low number of participants and the relatively brief follow-up period. The preliminary data show that a 1565-nm NAFL is significantly effective

Use of propranolol for parotid hemangioma.

Few specific reports have addressed propranolol as a treatment for parotid hemangioma, and its mechanism remains unclear.

Are arteriovenous malformations a causative factor for hypertrophic and nodular port-wine stains?

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