Reddy Kavitha K, Brauer Jeremy A, Idriss Munir H, Anolik Robert, Bernstein Leonard, Brightman Lori, Hale Elizabeth, Karen Julie, Weiss Elliot, Elston Dirk, Geronemus Roy G
Laser & Skin Surgery Center of New York, New York, NY, USA.
J Drugs Dermatol. 2013 Jan;12(1):66-71.
Pulsed dye laser treatment often results in port-wine stain (PWS) improvement; however, results vary. A frequency-doubled neodymium-doped yttrium aluminum garnet (Nd:YAG) laser that allows for shorter pulse widths along with large spot sizes and high fluences has been developed for the treatment of cutaneous vascular lesions.
A prospective, controlled study was performed in 5 adults with PWS using a frequency-doubled Nd:YAG laser (Excel V; Cutera Inc, Brisbane, CA) in 4 quadrants, using spot sizes of 6 to 10 mm, fluences of 4.8 to 9 J/cm2, and pulse durations of 3 to 6 ms. An adjacent control area was not treated. Each was assessed immediately posttreatment for purpura and edema and at 1 month for PWS color, size, texture, and thickness. Skin biopsies obtained immediately after and at 1 month posttreatment were evaluated.
All treatment quadrants displayed purpura. At 1-month follow-up, all treatment quadrants showed at least 1 grade of color improvement, from a minimum of 1% to 25% to a maximum of 51% to 75% improvement (12/20 quadrants with 1%-25% improvement, 3/20 with 26%-50%, 5/20 with 51%-75%, and 0/20 with 76%-100%). Histologic evaluation of treatment quadrants revealed vascular changes ranging 0.35 to 4 mm in depth. Immediately posttreatment, thrombi and extravasated red blood cells were observed in treatment quadrants. Histology at 1 month revealed decreased number and diameter of vessels in treatment quadrants (superficial vessels decreased by mean 1.1 vessels per section [13%], and diameter by 3.0 μm [47%], midlevel vessels decreased in number by 2.3 [20%], diameter by 2.42 μm [25%], and deep vessels decreased in number by 1.5 [83%], and diameter by 7.44 μm [88%]).
A single treatment with a short pulse width, frequency-doubled Nd:YAG laser resulted in safe and effective improvement of PWS, with up to 75% improvement in color observed at 1 month. Histologic evaluation demonstrated vascular injury at depths of 0.35 to 4 mm with a reduction in vessel number and size at multiple dermal levels.
脉冲染料激光治疗常可改善鲜红斑痣（PWS）；然而，效果存在差异。一种倍频掺钕钇铝石榴石（Nd:YAG）激光已被研发用于治疗皮肤血管病变，其脉冲宽度更短，光斑尺寸大且能量密度高。
对5例患有PWS的成人进行前瞻性对照研究，在4个象限使用倍频Nd:YAG激光（Excel V；Cutera公司，加利福尼亚州布里斯班），光斑尺寸为6至10mm，能量密度为4.8至9J/cm²，脉冲持续时间为3至6ms。相邻的对照区域未进行治疗。治疗后立即评估紫癜和水肿情况，1个月时评估PWS的颜色、大小、质地和厚度。对治疗后立即及1个月时获取的皮肤活检样本进行评估。
所有治疗象限均出现紫癜。在1个月的随访中，所有治疗象限均显示至少有1级颜色改善，改善程度从最小1%至25%到最大51%至75%（12/20个象限改善1%至25%，3/20个象限改善26%至50%，5/20个象限改善51%至75%，0/20个象限改善76%至100%）。治疗象限的组织学评估显示血管变化深度在0.35至4mm之间。治疗后立即观察到治疗象限有血栓和红细胞外渗。1个月时的组织学检查显示治疗象限血管数量和直径减少（浅层血管每切片平均减少1.1条血管[13%]，直径减少3.0μm[47%]，中层血管数量减少2.3条[20%]，直径减少2.42μm[25%]，深层血管数量减少1.5条[83%]，直径减少7.44μm[88%]）。
单次使用短脉冲宽度的倍频Nd:YAG激光治疗可安全有效地改善PWS，1个月时颜色改善高达75%。组织学评估显示在0.35至4mm深度存在血管损伤，多个真皮层的血管数量和大小均减少。
