Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)—A randomized controlled trial
Background and Objective Pulsed Dye Laser (PDL) is currently the gold standard treatment for port wine stains (PWS), although the degree of lesion blanching is variable and often unpredictable. This appears to be due to reformation and reperfusion of blood vessels. Rapamycin has shown potential as a...
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| creator | Greveling, Karin Prens, Errol P. van Doorn, Martijn B. |
| description | Background and Objective
Pulsed Dye Laser (PDL) is currently the gold standard treatment for port wine stains (PWS), although the degree of lesion blanching is variable and often unpredictable. This appears to be due to reformation and reperfusion of blood vessels. Rapamycin has shown potential as an antiangiogenic agent and may prevent the revascularization after PDL treatment. The objective of this study was to evaluate the efficacy of adjuvant use of (commercially available) topical rapamycin after PDL treatment in patients with PWS.
Materials and Methods
We conducted a prospective, intra‐patient, randomized controlled trial. Four treatment areas of 1 cm2 were created in each PWS. PDL‐only treatment was compared to the following three treatments: PDL + rapamycin, PDL + Erbium YAG laser ablation of the stratum corneum + rapamycin, and rapamycin monotherapy. We also compared PDL + Erbium YAG + rapamycin with PDL + rapamycin. The primary endpoint was the percentage clearance assessed colorimetrically at 6 months follow‐up. Secondary outcomes were photographic evaluation by an expert panel, patient satisfaction, treatment related pain, and safety.
Results
Fourteen patients completed the treatment protocol. The highest percentage clearance was achieved with PDL‐only treatment (mean [SD] 16% [34]), but there were no statistically significant differences between treatments. The best photographic evaluation and highest patient satisfaction were also achieved with PDL‐only treatment, but only the difference between PDL‐only and rapamycin monotherapy was statistically significant. The treatment related pain was well tolerated. Application‐site pruritus was a frequent occurring adverse event. Allergic contact dermatitis to rapamycin occurred in one patient. There were no serious adverse events.
Conclusion
Topical application of the commercially available solution of rapamycin (Rapamune® 0.1%) as an adjuvant to PDL treatment does not appear to improve PWS blanching. Lasers Surg. Med. 49:104–109, 2017. © 2016 Wiley Periodicals, Inc. |
| doi_str_mv | 10.1002/lsm.22548 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1868306936</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1826701420</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5708-65332ac2a0868fcd4e6bd7881115a37b2fad54ca1a468e381a257a8bcc1c19ad3</originalsourceid><addsrcrecordid>eNqNkU1rFTEUhoMo9ra68A9IwE0L3vYkM5PJLC-1VuEWBevC1XAmk5GUfIzJDOW66rb7_kJ_ibne1kVBcJWXnIfncHgJecXgmAHwE5vcMedVKZ-QBYNGLBsG7ClZAMtZQsP3yH5KVwBQcKifkz1e5yBktSC3l1Hj5LSfaBjoGOJEr43XNE1ofKJzMv47_TzbpHv6bqPpGpOOb-lZ7Mzs6LfV-cMP-p5OYTQKLY04otso4-lhMjFY4-Z09OvmbpUnvg_O_Mw2FfyUZzbHKRq0L8izAfOel_fvAfn6_uzy9MNy_en84-lqvVRVDXIpqqLgqDiCFHJQfalF19dSMsYqLOqOD9hXpUKGpZC6kAx5VaPslGKKNdgXB-Rw5x1j-DHrNLXOJKWtRa_DnFqWvQWIphD_gXJRAys5ZPTNI_QqzNHnQ7ZCXpclVFvh0Y5SMaQU9dCO0TiMm5ZBu62yzVW2f6rM7Ot749w53f8lH7rLwMkOuDZWb_5tatdfLnbK3-i7qOo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1862744056</pqid></control><display><type>article</type><title>Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)—A randomized controlled trial</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Greveling, Karin ; Prens, Errol P. ; van Doorn, Martijn B.</creator><creatorcontrib>Greveling, Karin ; Prens, Errol P. ; van Doorn, Martijn B.</creatorcontrib><description>Background and Objective
Pulsed Dye Laser (PDL) is currently the gold standard treatment for port wine stains (PWS), although the degree of lesion blanching is variable and often unpredictable. This appears to be due to reformation and reperfusion of blood vessels. Rapamycin has shown potential as an antiangiogenic agent and may prevent the revascularization after PDL treatment. The objective of this study was to evaluate the efficacy of adjuvant use of (commercially available) topical rapamycin after PDL treatment in patients with PWS.
Materials and Methods
We conducted a prospective, intra‐patient, randomized controlled trial. Four treatment areas of 1 cm2 were created in each PWS. PDL‐only treatment was compared to the following three treatments: PDL + rapamycin, PDL + Erbium YAG laser ablation of the stratum corneum + rapamycin, and rapamycin monotherapy. We also compared PDL + Erbium YAG + rapamycin with PDL + rapamycin. The primary endpoint was the percentage clearance assessed colorimetrically at 6 months follow‐up. Secondary outcomes were photographic evaluation by an expert panel, patient satisfaction, treatment related pain, and safety.
Results
Fourteen patients completed the treatment protocol. The highest percentage clearance was achieved with PDL‐only treatment (mean [SD] 16% [34]), but there were no statistically significant differences between treatments. The best photographic evaluation and highest patient satisfaction were also achieved with PDL‐only treatment, but only the difference between PDL‐only and rapamycin monotherapy was statistically significant. The treatment related pain was well tolerated. Application‐site pruritus was a frequent occurring adverse event. Allergic contact dermatitis to rapamycin occurred in one patient. There were no serious adverse events.
Conclusion
Topical application of the commercially available solution of rapamycin (Rapamune® 0.1%) as an adjuvant to PDL treatment does not appear to improve PWS blanching. Lasers Surg. Med. 49:104–109, 2017. © 2016 Wiley Periodicals, Inc.</description><identifier>ISSN: 0196-8092</identifier><identifier>EISSN: 1096-9101</identifier><identifier>DOI: 10.1002/lsm.22548</identifier><identifier>PMID: 27320685</identifier><identifier>CODEN: LSMEDI</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Academic Medical Centers ; Administration, Topical ; Adolescent ; Adult ; Biopsy, Needle ; congenital vascular malformations ; Erbium YAG laser ; Esthetics ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Lasers, Dye - therapeutic use ; Lasers, Solid-State - therapeutic use ; Low-Level Light Therapy - methods ; Male ; Middle Aged ; Netherlands ; Port-Wine Stain - pathology ; Port-Wine Stain - therapy ; Prospective Studies ; pulsed dye laser ; rapamycin ; sirolimus ; Sirolimus - therapeutic use ; Statistics, Nonparametric ; Treatment Outcome ; Vitaceae ; Young Adult</subject><ispartof>Lasers in surgery and medicine, 2017-01, Vol.49 (1), p.104-109</ispartof><rights>2016 Wiley Periodicals, Inc.</rights><rights>2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5708-65332ac2a0868fcd4e6bd7881115a37b2fad54ca1a468e381a257a8bcc1c19ad3</citedby><cites>FETCH-LOGICAL-c5708-65332ac2a0868fcd4e6bd7881115a37b2fad54ca1a468e381a257a8bcc1c19ad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flsm.22548$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flsm.22548$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27320685$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Greveling, Karin</creatorcontrib><creatorcontrib>Prens, Errol P.</creatorcontrib><creatorcontrib>van Doorn, Martijn B.</creatorcontrib><title>Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)—A randomized controlled trial</title><title>Lasers in surgery and medicine</title><addtitle>Lasers Surg Med</addtitle><description>Background and Objective
Pulsed Dye Laser (PDL) is currently the gold standard treatment for port wine stains (PWS), although the degree of lesion blanching is variable and often unpredictable. This appears to be due to reformation and reperfusion of blood vessels. Rapamycin has shown potential as an antiangiogenic agent and may prevent the revascularization after PDL treatment. The objective of this study was to evaluate the efficacy of adjuvant use of (commercially available) topical rapamycin after PDL treatment in patients with PWS.
Materials and Methods
We conducted a prospective, intra‐patient, randomized controlled trial. Four treatment areas of 1 cm2 were created in each PWS. PDL‐only treatment was compared to the following three treatments: PDL + rapamycin, PDL + Erbium YAG laser ablation of the stratum corneum + rapamycin, and rapamycin monotherapy. We also compared PDL + Erbium YAG + rapamycin with PDL + rapamycin. The primary endpoint was the percentage clearance assessed colorimetrically at 6 months follow‐up. Secondary outcomes were photographic evaluation by an expert panel, patient satisfaction, treatment related pain, and safety.
Results
Fourteen patients completed the treatment protocol. The highest percentage clearance was achieved with PDL‐only treatment (mean [SD] 16% [34]), but there were no statistically significant differences between treatments. The best photographic evaluation and highest patient satisfaction were also achieved with PDL‐only treatment, but only the difference between PDL‐only and rapamycin monotherapy was statistically significant. The treatment related pain was well tolerated. Application‐site pruritus was a frequent occurring adverse event. Allergic contact dermatitis to rapamycin occurred in one patient. There were no serious adverse events.
Conclusion
Topical application of the commercially available solution of rapamycin (Rapamune® 0.1%) as an adjuvant to PDL treatment does not appear to improve PWS blanching. Lasers Surg. Med. 49:104–109, 2017. © 2016 Wiley Periodicals, Inc.</description><subject>Academic Medical Centers</subject><subject>Administration, Topical</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Biopsy, Needle</subject><subject>congenital vascular malformations</subject><subject>Erbium YAG laser</subject><subject>Esthetics</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Immunohistochemistry</subject><subject>Lasers, Dye - therapeutic use</subject><subject>Lasers, Solid-State - therapeutic use</subject><subject>Low-Level Light Therapy - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Netherlands</subject><subject>Port-Wine Stain - pathology</subject><subject>Port-Wine Stain - therapy</subject><subject>Prospective Studies</subject><subject>pulsed dye laser</subject><subject>rapamycin</subject><subject>sirolimus</subject><subject>Sirolimus - therapeutic use</subject><subject>Statistics, Nonparametric</subject><subject>Treatment Outcome</subject><subject>Vitaceae</subject><subject>Young Adult</subject><issn>0196-8092</issn><issn>1096-9101</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1rFTEUhoMo9ra68A9IwE0L3vYkM5PJLC-1VuEWBevC1XAmk5GUfIzJDOW66rb7_kJ_ibne1kVBcJWXnIfncHgJecXgmAHwE5vcMedVKZ-QBYNGLBsG7ClZAMtZQsP3yH5KVwBQcKifkz1e5yBktSC3l1Hj5LSfaBjoGOJEr43XNE1ofKJzMv47_TzbpHv6bqPpGpOOb-lZ7Mzs6LfV-cMP-p5OYTQKLY04otso4-lhMjFY4-Z09OvmbpUnvg_O_Mw2FfyUZzbHKRq0L8izAfOel_fvAfn6_uzy9MNy_en84-lqvVRVDXIpqqLgqDiCFHJQfalF19dSMsYqLOqOD9hXpUKGpZC6kAx5VaPslGKKNdgXB-Rw5x1j-DHrNLXOJKWtRa_DnFqWvQWIphD_gXJRAys5ZPTNI_QqzNHnQ7ZCXpclVFvh0Y5SMaQU9dCO0TiMm5ZBu62yzVW2f6rM7Ot749w53f8lH7rLwMkOuDZWb_5tatdfLnbK3-i7qOo</recordid><startdate>201701</startdate><enddate>201701</enddate><creator>Greveling, Karin</creator><creator>Prens, Errol P.</creator><creator>van Doorn, Martijn B.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>P64</scope><scope>7X8</scope><scope>7QO</scope></search><sort><creationdate>201701</creationdate><title>Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)—A randomized controlled trial</title><author>Greveling, Karin ; Prens, Errol P. ; van Doorn, Martijn B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5708-65332ac2a0868fcd4e6bd7881115a37b2fad54ca1a468e381a257a8bcc1c19ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Academic Medical Centers</topic><topic>Administration, Topical</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Biopsy, Needle</topic><topic>congenital vascular malformations</topic><topic>Erbium YAG laser</topic><topic>Esthetics</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Immunohistochemistry</topic><topic>Lasers, Dye - therapeutic use</topic><topic>Lasers, Solid-State - therapeutic use</topic><topic>Low-Level Light Therapy - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Netherlands</topic><topic>Port-Wine Stain - pathology</topic><topic>Port-Wine Stain - therapy</topic><topic>Prospective Studies</topic><topic>pulsed dye laser</topic><topic>rapamycin</topic><topic>sirolimus</topic><topic>Sirolimus - therapeutic use</topic><topic>Statistics, Nonparametric</topic><topic>Treatment Outcome</topic><topic>Vitaceae</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Greveling, Karin</creatorcontrib><creatorcontrib>Prens, Errol P.</creatorcontrib><creatorcontrib>van Doorn, Martijn B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><jtitle>Lasers in surgery and medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Greveling, Karin</au><au>Prens, Errol P.</au><au>van Doorn, Martijn B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)—A randomized controlled trial</atitle><jtitle>Lasers in surgery and medicine</jtitle><addtitle>Lasers Surg Med</addtitle><date>2017-01</date><risdate>2017</risdate><volume>49</volume><issue>1</issue><spage>104</spage><epage>109</epage><pages>104-109</pages><issn>0196-8092</issn><eissn>1096-9101</eissn><coden>LSMEDI</coden><abstract>Background and Objective
Pulsed Dye Laser (PDL) is currently the gold standard treatment for port wine stains (PWS), although the degree of lesion blanching is variable and often unpredictable. This appears to be due to reformation and reperfusion of blood vessels. Rapamycin has shown potential as an antiangiogenic agent and may prevent the revascularization after PDL treatment. The objective of this study was to evaluate the efficacy of adjuvant use of (commercially available) topical rapamycin after PDL treatment in patients with PWS.
Materials and Methods
We conducted a prospective, intra‐patient, randomized controlled trial. Four treatment areas of 1 cm2 were created in each PWS. PDL‐only treatment was compared to the following three treatments: PDL + rapamycin, PDL + Erbium YAG laser ablation of the stratum corneum + rapamycin, and rapamycin monotherapy. We also compared PDL + Erbium YAG + rapamycin with PDL + rapamycin. The primary endpoint was the percentage clearance assessed colorimetrically at 6 months follow‐up. Secondary outcomes were photographic evaluation by an expert panel, patient satisfaction, treatment related pain, and safety.
Results
Fourteen patients completed the treatment protocol. The highest percentage clearance was achieved with PDL‐only treatment (mean [SD] 16% [34]), but there were no statistically significant differences between treatments. The best photographic evaluation and highest patient satisfaction were also achieved with PDL‐only treatment, but only the difference between PDL‐only and rapamycin monotherapy was statistically significant. The treatment related pain was well tolerated. Application‐site pruritus was a frequent occurring adverse event. Allergic contact dermatitis to rapamycin occurred in one patient. There were no serious adverse events.
Conclusion
Topical application of the commercially available solution of rapamycin (Rapamune® 0.1%) as an adjuvant to PDL treatment does not appear to improve PWS blanching. Lasers Surg. Med. 49:104–109, 2017. © 2016 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>27320685</pmid><doi>10.1002/lsm.22548</doi><tpages>6</tpages></addata></record> |
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| ispartof | Lasers in surgery and medicine, 2017-01, Vol.49 (1), p.104-109 |
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| subjects | Academic Medical Centers Administration, Topical Adolescent Adult Biopsy, Needle congenital vascular malformations Erbium YAG laser Esthetics Female Follow-Up Studies Humans Immunohistochemistry Lasers, Dye - therapeutic use Lasers, Solid-State - therapeutic use Low-Level Light Therapy - methods Male Middle Aged Netherlands Port-Wine Stain - pathology Port-Wine Stain - therapy Prospective Studies pulsed dye laser rapamycin sirolimus Sirolimus - therapeutic use Statistics, Nonparametric Treatment Outcome Vitaceae Young Adult |
| title | Treatment of port wine stains using Pulsed Dye Laser, Erbium YAG Laser, and topical rapamycin (sirolimus)—A randomized controlled trial |
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