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  • A Comparison of Acquired Port-wine Stain: DISCUSSION part 2

Most cases of port-wine stain (PWS) are congenital, but the acquired form of PWS has only recently been described. In 1939, Traub reported the first case of acquired port-wine stain (APWS). The average age of onset of APWS is usually after 1 year. M-any cases of acquired PWS have since been reported – , , but there has been little discussion about treatment. There have been only two reports investigating the efficacy of laser therapy in APWS. Dinehart et al found that APWS had generally a faster response to the PDL treatment than CPWS, however, they could not explain the exact mechanism because some patients responded rather poorly to laser treatment. Lanigan2 supposed that APWS’s telangiectatic nature, relatively sparse number and superficial site of ectatic vessels probably explained why the response was better than CPWS to laser therapy. Therefore, he concluded that patients with APWS could be expected to respond well to PDL therapy and fewer treatments were required than those patients with CPWS. But in these articles, only small numbers of patients were studied and the therapeutic results were not same in all patients with APWS. As for our experience of long pulsed dye laser in APWS therapy, the result was rather similar to that of Dinehart et al. The response to PDL in patients with APWS was controversial, so we undertook this study to find out whether there are some differences of histo- pathologic features of the two entities or not.

To demonstrate histopathologic differences between the two groups by using image analyzer, we compared APWS with CPWS by three parameters such as vessel area, percentage of vascular area, and vessel depth. This is not objective data, but we thought it not a problem when viewing comparison of the two groups. In our study, we measured vessels to a depth of 1 mm from the dermoepidermal junction. The reason for selecting this upper depth is based on mathematical modeling which predicts that only ectatic blood vessels at a depth of less than 800-900 p.m contribute to the visual appearance of the color of PWS. Another problem in measuring depth was that the epidermal base was not a straight line. Therefore we regarded that epidermal base was averaged into a straight line by roughly bisecting the line of papillary dermal tips and line of tip of rete ridges.

There were no statistically significant differences between APWS and CPWS. Limitations of this study such as small numbers of patients, only one biopsy specimen in each person, bias in method and so forth may affect the result.
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In conclusion there were no significant histo- pathologic differences of variables between APWS and CPWS. We could neither find any histopatho- logic differences that had an influence on therapeutic results, nor suggest any factors that explain the possibility of better response in APWS to the laser. In order to establish, therefore, whether there is a difference in the therapeutic response of PDL between the two entities, further investigation of other factors not involved in this study such as vessel wall thickness, luminal erythrocytes contents and so on, will be needed.

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