Indocyanine green-augmented diode laser treatment of port-wine stains: clinical and histological evidence for a new treatment option from a randomized controlled trial.

Abstract

BACKGROUND:

Complete clearance of port-wine stains (PWS) is difficult to achieve, mainly because of the resistance of small blood vessels to laser irradiation. Indocyanine green (ICG)-augmented diode laser treatment (ICG+DL) may overcome this problem.

OBJECTIVES:

To evaluate the feasibility of ICG+DL therapy of PWS and to compare the safety and efficacy of ICG+DL with the standard treatment, flashlamp-pumped pulsed dye laser (FPDL).

METHODS:

In a prospective randomized controlled clinical study, 31 patients with PWS were treated with FPDL (λ(em)=585 nm, 6 J cm(-2) , 0.45 ms pulse duration) and ICG+DL (λ(em)=810 nm, 20-50 J cm(-2) , 10-25 ms pulse duration, ICG-concentration: 2 mg kg(-1) body weight) in a split-face modus in one single treatment setting that included histological examination (haematoxylin and eosin, CD34). Two blinded investigators and the patients assessed clearance rate, cosmetic appearance and side-effects up to 3 months after treatment.

RESULTS:

ICG+DL therapy induced photocoagulation of medium and large blood vessels (>20 μm diameter) but not of small blood vessels. According to the investigators' assessment, clearance rates and cosmetic appearance were better after ICG+DL therapy than after FPDL treatment (P=0.114, P=0.291, respectively), although not up to a statistically significant level, whereas patients considered these parameters superior (P=0.003, P=0.006, respectively). On a 10-point scale indicating pain during treatment, patients rated ICG+DL to be more painful (5.81 ± 2.12) than FPDL treatment (1.61 ± 1.84).

CONCLUSION:

ICG+DL represents a new and promising treatment modality for PWS, but laser parameters and ICG concentration need to be further optimized.

• Authors: A Klein, R-M Szeimies, W Bäumler, F Zeman, S Schreml, U Hohenleutner, M Landthaler, M Koller, P Babilas
• Journal: The British journal of dermatology (Br J Dermatol) Vol. 167 Issue 2 Pg. 333-42 (Aug 2012) ISSN: 1365-2133 [Electronic] England
• PMID: 22435991 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

Chemical References

• Photosensitizing Agents
• Indocyanine Green

Topics

• Adolescent
• Adult
• Aged
• Analysis of Variance
• Feasibility Studies
• Female
• Humans
• Indocyanine Green (therapeutic use)
• Intraoperative Complications (etiology)
• Laser Therapy (adverse effects, methods)
• Lasers, Semiconductor (therapeutic use)
• Male
• Middle Aged
• Pain (etiology)
• Patient Preference
• Photosensitizing Agents (therapeutic use)
• Port-Wine Stain (pathology, surgery)
• Prospective Studies
• Treatment Outcome
• Young Adult