Analysis Of Multiple Skin Imaging Features In Port-wine Stain Patients With Photodynamic Therapy Resistance

Objective(s): In recent years,HMME-PDT has been developed as the most effective treatment for Port-wine stain.Currently,there are few studies evaluating the efficacy of HMME-PDT multiple treatments for port wine stain.And different skin images have different results in the evaluation of therapeutic efficacy and prognosis.In the current study,the conclusions of the same skin imaging method in Port-wine stain are different and even inconsistent.Therefore,in order to explore the characteristics of skin lesions and the differences of various skin imaging results in patients who were therapeutic resistance after multiple HMME-PDT,we retrospectively analyzed the medical records of port-wine stain treated with HMME-PDT for 3-5 times in our hospital during the past 5 years.Methods: A total of 78 eligible medical records of PWS were enrolled and divided into therapeutic resistance group and nonresistance group.The gender,age,nationality,lesion location,number of treatments,swelling degree,burning sensation and pain degree of the medical records were analyzed.Besides,a variety of skin imaging images such as VISIA,dermoscopy,high-frequency skin ultrasound(24MHz)and FSASI scores of the subjects were collected and compared its characteristics and application value in different treatment response.Results: There were no statistically significant differences in age,ethnicity,or mean number of HMME-PDT between the resistant and non-resistant groups.The proportion of males in the resistance group was higher than that in the nonresistance group(P=0.029 < 0.05).And in the therapeutic resistance group,84.6% of lesions were located in multiple segments(P=0.019 < 0.05),so the difference was statistically significant.There was no statistically significant difference between the resistant and nonresistant groups in the proportion of red,purple,and nodular thickening lesions,nor in the degree of burning sensation,pain,and swelling after treatment.Different types of port wine stain and different dermoscopic vascular patterns showed no statistical significance between the therapeutic resistance group and the nonresistance group.When VISIA facial analysis system combined with Image J quantified the area of lesions,the area reduction ratio of the resistance group was smaller(P< 0.001),and the difference was statistically significant.Among the different types of port wine stain,the red lesion area decreased the most after treatment(P=0.016 < 0.05),and the difference was statistically significant.FSASI score higher in the therapeutic resistance group before treatment(P= 0.013 < 0.05),statistically significant difference;Among different types of port wine stain,FSASI score of nodular thickening lesion was the highest,followed by purple lesion and red lesion was the lowest(P< 0.001),and the difference was statistically significant.The reduction rate of FSASI score after treatment was lower in the resistance group(P< 0.001),and the difference was statistically significant,but there was no statistically significant difference among the different types of port wine stain.There was a significant correlation between FSASI score before treatment and score reduction ratio after treatment(P=0.008 < 0.05),and the correlation coefficient was-0.34484,indicating a negative correlation.There was no statistically significant difference in skin thickness between the therapeutic resistance group and the nonresistance group under high-frequency skin ultrasound.Among different types of port wine stain,the nodular thickening lesion had a greater degree of skin thickness than the purple lesion and red lesion(P=0.042 < 0.05),and the difference was statistically significant.Blood flow level of facial lesions in ultramicrovascular SMi imaging was higher than neck lesions(P=0.027 < 0.05),and the difference was statistically significant.In different types of port wine stain,blood flow level was also statistically significant(P=0.026 < 0.05).But there was no significant difference in blood flow grade between the therapeutic resistance group and the nonresistance group(P=0.103 > 0.05).There was no significant difference in vascular type between the therapeutic resistance group and nonresistance group,and among different types of port wine stain.Conclusion(s): Male patients and large,multisegmental lesions with port wine stain were more likely to resist HMME-PDT.There was no significant difference in HMME-PDT resistance among different types of port wine stain.Pain,burning sensation,and swelling were not important predictors of therapeutic resistance.Different skin imaging methods have their advantages and disadvantages in evaluating HMME-PDT resistance of port wine stain.We can select VISIA Facial Analysis system with its red image to determine the extent of lesions,and then use FSASI score to assess the severity of lesions and predict the efficacy before treatment.Further,we can identify the vascular pattern of the skin lesions by dermoscopy.Finally,we quantified the degree of thickening of skin lesions,the level of blood flow signals in deep skin lesions,and the type of vascular malformations using high-frequency skin ultrasound.