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Aktuelle Dermatologie 2013; 39(07): 263-267
DOI: 10.1055/s-0033-1344223
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Laser- und Lichttherapie von kapillären Malformationen (Nävi flammei)

Laser- and Light Therapy of Capillary Malformations (Port-Wine Stains)
A. Klein
Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
,
W. Bäumler
Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
› Author Affiliations
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Publication History

Publication Date:
10 July 2013 (online)

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Zusammenfassung

Kapilläre Malformationen (Nävi flammei) werden bei unter 1 % der Neugeborenen beobachtet. Sie treten überwiegend im Kopf-Hals-Bereich auf und können sehr stigmatisierend für die Betroffenen sein. Blitzlampen-gepumpte gepulste Farbstofflaser stellen weiterhin die Therapie der Wahl dar und können bereits im Säuglingsalter eingesetzt werden. Aber auch inkohärente Lichtquellen wie die Hochenergetische Blitzlampe (HBL) werden zunehmend erfolgreich eingesetzt. Während bei den meisten Patienten eine gute Aufhellung des Nävus flammeus durch die Laser- oder HBL-Therapie erzielt werden kann, wird nur selten ein komplettes Verschwinden der Läsion erreicht. Daher wären neue, effektivere Therapieoptionen wünschenswert.

Abstract

Capillary malformations (port-wine stains) have an incidence below 1 % in neonates. The majority of lesions occur in the head and neck area and may have important cosmetic and psychological implications for the patients. Flashlamp-pumped pulsed dye lasers are still the treatment of choice for the therapy of capillary malformations and can already be used in infancy. Incoherent light sources like Intense pulsed light (IPL) devices are effective for the treatment of capillary malformations, as well. Laser and IPL treatment achieves good clearance in the majority of port-wine stains, but complete clearance is rare. Thus, new therapeutic options are urgently required.

 

  • Literatur

  • 1 Alper JC, Holmes LB. The incidence and significance of birthmarks in a cohort of 4,641 newborns. Pediatr Dermatol 1983; 1: 58-68
    CrossrefPubMedGoogle Scholar
  • 2 Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220: 524-527
    CrossrefPubMedGoogle Scholar
  • 3 Tan OT, Sherwood K, Gilchrest BA. Treatment of children with port-wine stains using the flashlamp-pulsed tunable dye laser. N Engl J Med 1989; 320: 416-421
    CrossrefPubMedGoogle Scholar
  • 4 Klein A, Baumler W, Landthaler M et al. Laser and IPL treatment of port-wine stains: therapy options, limitations, and practical aspects. Lasers Med Sci 2011; 26: 845-859
    CrossrefPubMedGoogle Scholar
  • 5 Hulsmanns RFJH. Congenital angiodysplastic syndromes associated with primary or secondary varicosis and/or phlebectasias. Scope Phlebol Lymphol 1995; 2: 8-16
    PubMedGoogle Scholar
  • 6 Fiskerstrand EJ, Svaasand LO, Kopstad G et al. Photothermally induced vessel-wall necrosis after pulsed dye laser treatment: lack of response in port-wine stains with small sized or deeply located vessels. J Invest Dermatol 1996; 107: 671-675
    CrossrefPubMedGoogle Scholar
  • 7 Smoller BR, Rosen S. Port-wine stains. A disease of altered neural modulation of blood vessels?. Arch Dermatol 1986; 122: 177-179
    CrossrefPubMedGoogle Scholar
  • 8 Boon LM, Mulliken JB, Vikkula M. RASA1: variable phenotype with capillary and arteriovenous malformations. Curr Opin Genet Dev 2005; 15: 265-269
    CrossrefPubMedGoogle Scholar
  • 9 Orten SS, Waner M, Flock S et al. Port-wine stains. An assessment of 5 years of treatment. Arch Otolaryngol Head Neck Surg 1996; 122: 1174-1179
    CrossrefPubMedGoogle Scholar
  • 10 Zenzie HH, Altshuler GB, Smirnov MZ et al. Evaluation of cooling methods for laser dermatology. Lasers Surg Med 2000; 26: 130-144
    CrossrefPubMedGoogle Scholar
  • 11 Koster PH, van der Horst CM, Bossuyt PM et al. Prediction of portwine stain clearance and required number of flashlamp pumped pulsed dye laser treatments. Lasers Surg Med 2001; 29: 151-155
    CrossrefPubMedGoogle Scholar
  • 12 Nguyen CM, Yohn JJ, Huff C et al. Facial port wine stains in childhood: prediction of the rate of improvement as a function of the age of the patient, size and location of the port wine stain and the number of treatments with the pulsed dye (585 nm) laser. Br J Dermatol 1998; 138: 821-825
    CrossrefPubMedGoogle Scholar
  • 13 Sommer S, Seukeran DC, Sheehan-Dare RA. Efficacy of pulsed dye laser treatment of port wine stain malformations of the lower limb. Br J Dermatol 2003; 149: 770-775
    CrossrefPubMedGoogle Scholar
  • 14 Liu H, Dang Y, Chai X et al. Treatment of port-wine stains with the 595-nm pulsed dye laser: a pilot study in Chinese patients. Clin Exp Dermatol 2007; 32: 646-649
    CrossrefPubMedGoogle Scholar
  • 15 Nagore E, Requena C, Sevila A et al. Thickness of healthy and affected skin of children with port wine stains: potential repercussions on response to pulsed dye laser treatment. Dermatol Surg 2004; 30: 1457-1461
    CrossrefPubMedGoogle Scholar
  • 16 Renfro L, Geronemus RG. Anatomical differences of port-wine stains in response to treatment with the pulsed dye laser. Arch Dermatol 1993; 129: 182-188
    CrossrefPubMedGoogle Scholar
  • 17 Chapas AM, Eickhorst K, Geronemus RG. Efficacy of early treatment of facial port wine stains in newborns: a review of 49 cases. Lasers Surg Med 2007; 39: 563-568
    CrossrefPubMedGoogle Scholar
  • 18 Wimmershoff MB, Wenig M, Hohenleutner U et al. [Treatment of port-wine stains with the flash lamp pumped dye laser. 5 years of clinical experience]. Hautarzt 2001; 52: 1011-1015
    CrossrefPubMedGoogle Scholar
  • 19 Scherer K, Lorenz S, Wimmershoff M et al. Both the flashlamp-pumped dye laser and the long-pulsed tunable dye laser can improve results in port-wine stain therapy. Br J Dermatol 2001; 145: 79-84
    CrossrefPubMedGoogle Scholar
  • 20 Chang CJ, Kelly KM, Van Gemert MJ et al. Comparing the effectiveness of 585-nm vs 595-nm wavelength pulsed dye laser treatment of port wine stains in conjunction with cryogen spray cooling. Lasers Surg Med 2002; 31: 352-358
    CrossrefPubMedGoogle Scholar
  • 21 Asahina A, Watanabe T, Kishi A et al. Evaluation of the treatment of port-wine stains with the 595-nm long pulsed dye laser: a large prospective study in adult Japanese patients. J Am Acad Dermatol 2006; 54: 487-493
    CrossrefPubMedGoogle Scholar
  • 22 Troilius A, Wrangsjo B, Ljunggren B. Patients with port-wine stains and their psychosocial reactions after photothermolytic treatment. Dermatol Surg 2000; 26: 190-196
    CrossrefPubMedGoogle Scholar
  • 23 Alster TS, Tanzi EL. Combined 595-nm and 1,064-nm laser irradiation of recalcitrant and hypertrophic port-wine stains in children and adults. Dermatol Surg 2009; 35: 914-918 discussion 918 – 919
    CrossrefPubMedGoogle Scholar
  • 24 Yang MU, Yaroslavsky AN, Farinelli WA et al. Long-pulsed neodymium:yttrium-aluminum-garnet laser treatment for port-wine stains. J Am Acad Dermatol 2005; 52: 480-490
    CrossrefPubMedGoogle Scholar
  • 25 McGill DJ, MacLaren W, Mackay IR. A direct comparison of pulsed dye, alexandrite, KTP and Nd:YAG lasers and IPL in patients with previously treated capillary malformations. Lasers Surg Med 2008; 40: 390-398
    CrossrefPubMedGoogle Scholar
  • 26 Faurschou A, Togsverd-Bo K, Zachariae C et al. Pulsed dye laser vs. intense pulsed light for port-wine stains: a randomized side-by-side trial with blinded response evaluation. Br J Dermatol 2009; 160: 359-364
    CrossrefPubMedGoogle Scholar
  • 27 Evans AV, Robson A, Barlow RJ et al. Treatment of port wine stains with photodynamic therapy, using pulsed dye laser as a light source, compared with pulsed dye laser alone: a pilot study. Lasers Surg Med 2005; 36: 266-269
    CrossrefPubMedGoogle Scholar
  • 28 Qin ZP, Li KL, Ren L et al. Photodynamic therapy of port-wine stains – a report of 238 cases. Photodign Photodyn Ther 2007; 4: 53-59
    PubMedGoogle Scholar
  • 29 Gao K, Huang Z, Yuan KH et al. Side-by-side comparison of photodynamic therapy (PDT) and pulsed dye laser (PDL) treatment of port-wine stain (PWS) birthmarks. Br J Dermatol 2012; Nov 8. [Epub ahead of print]
    PubMedGoogle Scholar
  • 30 Iijima T, Aoyagi T, Iwao Y et al. Cardiac output and circulating blood volume analysis by pulse dye-densitometry. J Clin Monit 1997; 13: 81-89
    CrossrefPubMedGoogle Scholar
  • 31 Klein A, Szeimies RM, Baumler W et al. Indocyanine green-augmented diode laser treatment of port-wine stains: clinical and histological evidence for a new treatment option from a randomized controlled trial. Br J Dermatol 2012; 167: 333-342
    CrossrefPubMedGoogle Scholar
  • 32 Finley JL, Barsky SH, Geer DE et al. Healing of port-wine stains after argon laser therapy. Arch Dermatol 1981; 117: 486-489
    CrossrefPubMedGoogle Scholar
  • 33 Jia W, Sun V, Tran N et al. Long-term blood vessel removal with combined laser and topical rapamycin antiangiogenic therapy: implications for effective port wine stain treatment. Lasers Surg Med 2010; 42: 105-112
    CrossrefPubMedGoogle Scholar
  • 34 Chang CJ, Hsiao YC, Mihm Jr MC et al. Pilot study examining the combined use of pulsed dye laser and topical Imiquimod versus laser alone for treatment of port wine stain birthmarks. Lasers Surg Med 2008; 40: 605-610
    CrossrefPubMedGoogle Scholar