A proposed scoring system for facial port-wine stain evaluation: Facial port-wine stain area and severity index

Influential Factors in the Efficacy and Safety of Hemoporfin-Mediated Photodynamic Therapy for Facial Port-Wine Stains

BACKGROUND

Hemoporfin-mediated photodynamic therapy (HMME-PDT) is a novel and promising treatment for port-wine stains (PWS); however, the factors affecting the efficacy and safety are controversial.

AIM

In this study, the relationship between influential factors and the efficacy and safety of HMME-PDT for facial PWS was clarified.

METHODS

In this retrospective study, 155 patients suffering from facial PWS who underwent HMME-PDT at 2-3 months interval were included. The efficacy was evaluated by the facial PWS area and severity index (FSASI) scoring system based on pre- and post-treatment photographs of the lesion. The demographic characteristics, lesion patterns, treatment history, number of treatment sessions, and adverse events were also recorded.

RESULTS

After the first and second sessions of HMME-PDT, 61.9% and 92.9% of patients responded, respectively. The lesion subtype, degree of lip involvement, and number of HMME-PDT sessions were associated with the efficacy of HMME-PDT (p = 0.014, p = 0.034, p < 0.001, and respectively). Logistic regression analysis confirmed that the patients with red-type PWS (p = 0.019) and more HMME-PDT sessions (≥ 2) (p < 0.001) showed an association with a better response to HMME-PDT. The response rate was higher for lesions on the mandibular prominence area than that on the forehead area (p = 0.031). No photosensitivity or systemic adverse reactions were reported. Most adverse effects were well tolerated in all patients. Furthermore, the severity of crust was found positively associated with the efficacy (p < 0.001).

CONCLUSION

HMME-PDT is an effective and safe treatment approach for treating facial PWS. Patients who had red-type, nonforehead area, and more treatment sessions showed an association with better efficacy.

Quantitative analysis of lesion images to evaluate the efficiency of vascular-targeted photodynamic therapy for port-wine stains: Four case reports

SIGNIFICANCE

Vascular-targeted photodynamic therapy (V-PDT) is a clinically approved therapeutic approach for treating vascular-related diseases, such as port-wine stains (PWS). For accurate treatment, varying light irradiance is required for different lesions due to the irregularity of vascular size, shape and degree of disease, which commonly alters during different stages of V-PDT. This makes quantitative analysis of the treatment efficiency urgently needed.

APPROACH

Lesion images pre- and post- V-PDT treatment of patients with PWS were used to construct a quantitative method to evaluate the differences among lesions. Image analysis techniques were applied to evaluate the V-PDT efficiency for PWS by determining the Euclidean distances and two-dimensional correlation coefficients.

RESULTS

According to the image analysis, V-PDT with good treatment efficiency resulted in a larger Euclidean distance and a smaller correlation coefficient compared with the case having lower V-PDT efficiency.

CONCLUSIONS

A new method to quantify the Euclidean distances and correlation coefficients has been proposed, which is promising for the quantitative analysis of V-PDT efficiency for PWS.

Three-dimensional image-guided topical photodynamic therapy system with light dosimetry dynamic planning and monitoring

Photodynamic therapy (PDT) has shown significant potential for skin disease treatment. As a key element, light is critical to influencing its treatment outcome, and light dosimetry is an issue of much concern for researchers. However, because of three-dimensional irregularity in shape and patient's movement during the therapy, irradiance hardly keeps uniform on the lesion and flux measurement remains a challenge. In this work, we report the development of a three-dimensional image-guided PDT system, and the method of dynamic irradiance planning and flux monitoring for lesions in different poses. This system comprises a three-dimensional camera for monitoring patients' movement during therapy, a computer for data analysis and processing, and a homemade LED array for forming uniform irradiance on lesions. Simulations on lesions of the face and arm show that the proposed system significantly increases effective therapy area, enhances irradiance uniformity, is able to visualize flux on the lesion, and reduces risks of burns during PDT. The developed PDT system is promising for optimizing procedures of PDT and providing better treatment outcomes by delivering controllable irradiance and flux on lesions even when a patient is moving.