Clinical And Experimental Research On Pulsed Dye Laser Therapy For Superficial Hemangioma

PartⅠ Efficacy and Side Effect in Chinese SuperficialHemangiomaTreated by595nm Pulsed DyeLaser--Results of10-year AnalysisBackground：The595nm tunable pulsed dye laser（PDL） has been used in China formore than10years clinically. However, no studies about its effect and side-effect in thetreatment of superficial hemangioma have been documented.Objective: This study was designed to retrospectively summarize595nm PDL usage inChinese patients.Methods: Infant patients with superficial hemangioma, who had received595nmtunable pulsed dye laser treatment in our laser center in the last10years, were recruited.Detailed demographics, results of assessment about their degree of clearance andclinical examination for treatment complications were entered into SASS10.0versiondatabase, and statistical analyses were conducted.Results:657cases with superficial hemangioma were recruited from the total1037cases treated by595nm PDL during the period time. The overall effectiveness rate was91.17%. Female patients respond better than male, the difference was statisticallysignificant (P<0.001). Lesions at different part of the body respond differently to thetreatment with lesions on extremities show the best result. The response rate does notincrease with time of treatments. The most common side-effects were pigment changesand skin atrophy, which usually resolve spontaneously and disappear completely in afew months. Conclusions: Our experience confirmed the satisfactory clinical efficacy and safety ofthe595nm tunable pulse dye laser in the treatment of childhood superficialhemangioma. PART Ⅱ Series research of595nm pulsed dye laser inthe treatment of superficial hemangiomaPARTⅡ.1Pulsed dye laser in the treatment of infants withsuperficial hemangioma located on facial andlimb:a clinical comparative studyObjective: There is no research about the natural outcome or prognosis afterintervention in the patients with hemangioma in different parts. The aim of this study isto compare efficacy and adverse reaction of hemangioma located on facial and limbtreated by595nm pulsed dye laser.Methods: Retrospective analysis of595nmPDL in the treatment of superficialhemangioma cases in our department from August2002to July2012with period of10years. A total of313cases were enrolled, including214cases which lesion located onface (Group I),99cases on limbs (Group II). Evaluation of curative effect was used tocompare skin photo before and after treatment, completed by the patients`guardian, andsenior dermatologists who did not participate in the treatment. The patient age, skin type,lesion site, size et al was also analyzed. The treatment results were classified according to recur, excellence, valid and invalid, and analyzed using SASS10.0statistical softwareduring two groups, and adverse reaction was also analyzed.Results: In group I, the cure rate was35.1%, effective rate was88.8%; and in group II,the cure rate was60.6%, effective rate was100%, there was significant differencebetween two groups (p<0.01). There was no significant difference about adversereaction between two groups (50%vs44.4%).Conclusion: Limb SH response to595nmPDL treatment is better than that of facial SH,there is no significant difference about adverse reaction between two groups. PartⅡ.2A study of gender affect the curative ofhemangioma treated by595nm Pulsed dye laserObjective：There is difference about morbidity in the patients with infantile superficialhemangioma between the sexes, whether estrogen play a role is unclear. Pulsed dyelaser (PDL) can be safe and effective in the treatment of superficial hemangioma ininfants, but the gender does play a role in the disease process is not clear. This studywas a retrospective analysis10years of data, uses595nm PDL for treatment of infantilesuperficial hemangioma, in our department, especially the difference result existedbetween the sexes, and combined with blood estradiol levels part with hemangiomawere measured. The aim of this study is to explore whether gender affects the progressand prognosis of hemangioma. Methods：A retrospective study method was used to analysis gender differences resultsfor PDL in the treatment patients with superficial hemangioma from2002August to2012July in our hospital. During the same period, serum E2level was detected withradioimmunoassay method in some children with hemangioma and children with lungdiseases, but non hemangiomas.Results：657cases of hemangiomas were enrolled, including261male cases,396female cases. Male patients’ cure rate was41.61%, inefficiency was10.73%; femalepatients’ cure rate was38.64%, inefficiency was7.58%. Wilcoxon-Rank sum test wasused, because grouping variable are unordered data, and target variable are ordered data,result shown effect value Z=-19.807, P<0.001, sum of ranks in female> male, it issuggested that there is statistical significance between female and male gorup, femalepatients are more effect than male.40cases of hemangioma in children (male14, female26) and20cases of non hemangiomas in children enrolled for serum E2level weredetermination.E2value were27.245±19.079pg/ml vs11.385±5.506pg/ml correspondto the group hemangioma vs non hemangioma group. There was statistically significantdifference between two groups (P <0.001). And there was statistically significantdifference about serum E2level between male hemangioma and female hemangioma(P=0.01).Conclusion: The estradiol may play a role in hemangioma proliferation, differentgender differences may be effect results in the children with hemangioma treated withPDL. PartⅡ.3Study on therapeutic outcome for superficialhemangioma treated by595nm Pulsed dye laseraffected by the timing of starting treatmentObjective: Pulsed dye laser (PDL) is the infantile superficial hemangioma (SH) of asafe and effective treatment, but the treatment period hemangioma choice iscontroversial. This study analyzed the relationship between595nmPDL treatmentresults of the SH and the timing of starting treatment, clear whether there areappropriate treatment period.Methods: Retrospective analysis of595nmPDL in treatment of infant SH cases in ourdepartment from2002August to the2012July period of10years according to startingtreatment age within24months. According to the timing of starting treatment age,divided into0-3month (group A),4-9month (group B),10-18month (group C) and19-24month (group D) of four groups. The main evaluation between the four groups forthe first time in PDL treated patients; the lesions subsided whether there are differencesbetween the degree and adverse reaction.Results:549patients were selected, the A group of300cases,121cases were cured,101cases markedly effective,49cases effective,29cases invalid,164cases of adversereactions occur;184cases in group B,72cases were cured,74cases markedly effective,29cases effective,9cases invalid,88cases of adverse reactions occur; C group of49cases,23cases were cured,14cases markedly effective,8cases effective,4casesinvalid,22cases of adverse reactions occur;16cases in group D,8cases were cured,5cases markedly effective,3cases effective,0cases invalid,7cases of adverse reactionsoccur. There are no significant differences among the groups about effect (P=0.692) andadverse reactions (P=0.332). Conclusion: PDL is a safe and effective method for the treatment of infantile SH, butwithin2years old children, timing of starting treatment has little influence on theprognosis. PartⅡ.4Topical ALA administration followed by irradiationwith PDL and PDL in treatment of superficialhemangioma—a controlled clinical studyObjectives: The role of pulsed dye lasers (PDL) and photodynamic therapy (PDT) inthe treatment of superficial hemangioma (SH) are not satisfactory for all patients. Thepurpose of this study was to evaluate the safety and efficacy of the method that topicalapplication of ALA spreading followed by595-nm PDL compared with595-nm PDLalone in treatment of SH.Methods: We did a prospective, randomized controlled trial in which193patients withSH were enrolled. We assigned patients to receive PDL treatment (PDL group) or local5-ALA application and then irradiation with595nm PDL(ALA-PDL group), followedup6months after last treatment session, and evaluate the differences of the curativeeffect and the adverse reaction between the two groups. The main outcome measureswere assessed according to the proportion of the patients whose lesions were completelycleared or not significantly improved, adverse reactions including pigmentarydisturbance, skin atrophy, ulceration, infection and so on. Questionnaires were used to investigate the patients’ satisfactory degree. The data obtained are computed andanalyzed via SPSS Version17.0.Results: All165patients with SH completed the study, which included119patientswho were in PDL group and46patients who were in ALA-PDL group. The number ofpatients whose lesions showed complete clearance or minimum residual signs at0.5year follow up was significantly different in the PDL group and ALA-PDL group(44,37.0%, vs31,67.4%). Lesions showed no obvious change was significantly differentin the PDL group and ALA-PDL group (2,1.7%, vs11,22.0%). There were significantdifferences about effect between the two groups, ALA-PDL was better than PDL alonein the treatment of SH.(X2=10.302, p=0.001) Adverse reactions between the twogroups had no obvious difference (42.9%vs47.8%, X2=3.32, p=0.654).Conclusion: Topical ALA administration followed by irradiation with a595nm PDL ismore effective in the treatment for SH, compared with PDL alone. Part Ⅲ Investigation of595nm PDL on the growth ofhemangioma in nude mice and its mechanismObjective: Infantile hemangioma is the most common benign tumor in children, itspathological mechanism is not clear; lack of an ideal model for studying is one of themain reasons hindering the in-depth study on the pathogenesis of hemangioma. Thepurpose of this study is to investigate the role and mechanism of PDL on hemangioma by establishment of vascular tumor in nude mice animal model, and using595nmpulsed dye laser (PDL) on hemangioma in established nude mice models.Methods: Using tissue transplantation, infant’s proliferative phase capillaryhemangioma surgical specimens were cut into small pieces under sterile conditions,implanted subcutaneously into nude mice, made of infantile hemangiomas in nude micexenograft animal models. Transplant60days later, take the transplants were successfulexperimental animal model of randomized controlled trials, divided into3experimentalgroups were given different interventions. A group intervened by595nm PDL, B groupintervened by Triamcinolone Acetonide0.05ml, and C group without intervention.Given different interventions, hemangioma xenograft model of tumor volumemeasurement, monitoring of vascular tumor growth in nude mice model in vivo;experimental nude mouse model were sacrificed2weeks after treatment to remove thehemangioma made of slices, HE staining for histological analysis, and forimmunohistochemistry staining of the expression of VEGF、MMP-2、TIMP-2. Using theSPSS17.0statistical software for all experimental results were analyzed statistically, P<0.05was thought to be significant difference.Results: Immunohistochemistry revealed CD31and CD34were positive expression ingrafted hemangioma tissue, CD31and CD34localized in the membrane of vascularendothelial cells. Produced by hemangioma xenograft model of growth is good, thecontrol group nude mouse model of vascular aneurysm volume continues to increase,the gross and microscopic observation of vascular aneurysm was the proliferation ofchange of the specimen; the others groups nude mouse model of vascular aneurysmvolume were reduced. The hemangioma tumor volume between groups were significantdifferences, tissue observed reduced vascular density, tumor atrophy, degeneration,occlusion of the vessel lumen, rupture, fat and fibrous tissues in the vascular infiltrationwere observed both A and B groups. The positive expression of MMP-2, VEGF in control group was significantly higher than that in A group and B group. The positiverate of TIMP-2was lower in group C than in the A and B group.Conclusion: Planting of human subeutnaeous hemnagiomas onto nude micesubeutnaeously is a feasible way to establish a model of human hemnagioma. The studyconfirmed that action of595nmPDL on vascular can reduced MMP-2and VEGFreleasing by action of blocking vessel.