Enhanced port-wine stain lightening achieved with combined treatment of selective photothermolysis and imiquimod.

Abstract

BACKGROUND:

Pulsed dye laser (PDL) is the gold standard for treatment of port-wine stain (PWS) birthmarks but multiple treatments are required and complete resolution is often not achieved. Posttreatment vessel recurrence is thought to be a factor that limits efficacy of PDL treatment of PWS. Imiquimod 5% cream is an immunomodulator with antiangiogenic effects.

OBJECTIVE:

We sought to determine if application of imiquimod 5% cream after PDL improves treatment outcome.

METHODS:

Healthy individuals with PWS (n = 24) were treated with PDL and then randomized to apply posttreatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements (Commission Internationale de l'Eclairage L∗a∗b∗ colorspace) for 57 PWS sites (multiple sites per patient) were taken at baseline and compared with measurements taken 8 weeks posttreatment. The Δa∗ (change in erythema) and ΔE (difference in color between normal-appearing skin and PWS skin) were measured to quantify treatment outcome.

RESULTS:

Two patients developed minor skin irritation. Other adverse effects were not noted. Average ∆a∗ was 0.43 for PDL + placebo sites (n = 25) and 1.27 for PDL + imiquimod sites (n = 32) (P value = .0294) indicating a greater reduction in erythema with imiquimod. Average ∆E was 2.59 for PDL + placebo and 4.08 for PDL + imiquimod (P value = .0363), again indicating a greater color improvement with imiquimod.

LIMITATIONS:

Effects were evaluated after a single treatment and duration of effect is unknown.

CONCLUSION:

Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy.

• Authors: Anne Marie Tremaine, Jennifer Armstrong, Yu-Chih Huang, Leila Elkeeb, Arisa Ortiz, Ronald Harris, Bernard Choi, Kristen M Kelly
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 66 Issue 4 Pg. 634-41 (Apr 2012) ISSN: 1097-6787 [Electronic] United States
• PMID: 22244840 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Chemical References

• Adjuvants, Immunologic
• Aminoquinolines
• Imiquimod

Topics

• Adjuvants, Immunologic (therapeutic use)
• Adolescent
• Adult
• Aged
• Aminoquinolines (therapeutic use)
• Combined Modality Therapy
• Female
• Humans
• Imiquimod
• Lasers, Dye (therapeutic use)
• Male
• Middle Aged
• Port-Wine Stain (drug therapy, surgery)
• Single-Blind Method
• Young Adult