A Comparison of Acquired Port-wine Stain: DISCUSSION
In capillary malformations, there are two types: port-wine stain (PWS) and telangiectasia. PWS is one of the most common types of capillary malformation and occurs as pink to red macules or patches, usually on a unilateral side. The color of the lesion tends to gradually deepen with time. The lesion grows proportionately and becomes raised and nodular as a result. Although the initial nature is similar to PWS, fading macular stains, referred to as stork bite or salmon patch, are located most commonly on the nape of the neck, the eyelids, and the glabella and may disappear spontaneously between 1 and 3 years of age. In these cases, there is no need for treatment.
In all cases of PWS, regardless of their onset, pulsed dye laser (PDL) therapy is the treatment of choice. Not all patients however will respond to laser therapy and many studies have been done to investigate the variables influencing the response of PWS to the PDL. The possible variables include clinical features such as lesion color, location and the age of patient and pathologic parameters such as vessel diameter, vascular area, vessel depth, vessel wall thickness, and the amount of erythrocytes in vessels. To demonstrate correlation between clinical features and therapeutic response, many investigations were done with no unanimity. Histopathologic examinations of PWS have also been done to establish the relationship between pathologic parameters and therapeutic responses – , – . Hohen- leutner et al confirmed histochemically in post- PDL treated PWS biopsies, superficial PWS vessels 4 JJ Lee, et al.
of a diameter up to 150 p.m were completely coagulated. With increasing vessel diameter, strong superficial hemoglobin absorption led only to partial vessel wall coagulation. cialis 10 mg
Also, deeper vessels were not coagulated because of shadowing from superficial vessels. In addition, the overall coagulated depth was limited to a maximum of only 0.65 mm. Fiskerstrand et al examined pretreatment biopsies in 30 patients with PWS. They found that the vessels of the good responders were located significantly more superficially than the vessel of the moderate and poor responders, and the poor responders had significantly smaller vessels than those of the moderate and good responders. The authors concluded that the therapeutic result was dependent on both the vessel diameter and its depth. Eubanks and McBurney used videomicroscopy and found that PWS in areas that typically respond well to laser treatment (V3 dermatome, neck, and trunk) were more likely to have a superficial pattern and PWS in areas that have a poorer response to therapy (V2 dermatome, distal extremities) were more likely to have a deeper pattern. Hence, it was suggested that both the depth and the diameter of the ectatic blood vessels in PWS have influence on the response to PDL.