Original Article
Capillary Malformations Treated With Sequential Pulsed Dye and Nd:YAG Laser Therapy: A Retrospective Study
Malformaciones capilares tratadas con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo
Read
5925
Timeswas read the article
2225
Total PDF
3700
Total HTML
Share statistics
array:24 [ "pii" => "S1578219017304237" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.12.010" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1820" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:155-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 104 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 80 "PDF" => 21 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731017305549" "issn" => "00017310" "doi" => "10.1016/j.ad.2017.10.002" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1820" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:155-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 264 "formatos" => array:2 [ "HTML" => 133 "PDF" => 131 ] ] "es" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Malformaciones capilares tratadas con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:3 [ 0 => "es" 1 => "es" 2 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "155" "paginaFinal" => "161" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Capillary Malformations Treated With Sequential Pulsed Dye and Nd:YAG Laser Therapy: A Retrospective Study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0020" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1085 "Ancho" => 1102 "Tamanyo" => 112298 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Alcántara-González, P. Boixeda, M.T. Truchuelo-Díez, N. Jiménez-Gómez, B. Pérez-García, L. Pérez-Carmona, P. Jaén Olasolo" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Alcántara-González" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Boixeda" ] 2 => array:2 [ "nombre" => "M.T." "apellidos" => "Truchuelo-Díez" ] 3 => array:2 [ "nombre" => "N." "apellidos" => "Jiménez-Gómez" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "Pérez-García" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Pérez-Carmona" ] 6 => array:2 [ "nombre" => "P." "apellidos" => "Jaén Olasolo" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0020"></elsevierMultimedia></p></span>" ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219017304237" "doi" => "10.1016/j.adengl.2017.12.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017304237?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305549?idApp=UINPBA000044" "url" => "/00017310/0000010900000002/v1_201803020417/S0001731017305549/v1_201803020417/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219017304249" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.12.011" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1833" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:162-72" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 109 "formatos" => array:3 [ "EPUB" => 5 "HTML" => 72 "PDF" => 32 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Diagnostic Tools to Use When We Suspect an Allergic Reaction to a Tattoo: A Proposal Based on Cases at Our Hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "162" "paginaFinal" => "172" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Qué procedimientos diagnósticos deberíamos realizar ante una sospecha de reacción alérgica a un tatuaje? Propuesta basada en nuestra casuística" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 672 "Ancho" => 950 "Tamanyo" => 117929 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Papular-lichenoid pattern in a patients with a probable allergic reaction to red tattoo ink. The color in this figure can only be fully appreciated in the electronic version of the article.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. González-Villanueva, J.F. Silvestre Salvador" "autores" => array:2 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "González-Villanueva" ] 1 => array:2 [ "nombre" => "J.F." "apellidos" => "Silvestre Salvador" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305896" "doi" => "10.1016/j.ad.2017.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305896?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017304249?idApp=UINPBA000044" "url" => "/15782190/0000010900000002/v1_201803020443/S1578219017304249/v1_201803020443/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219017304225" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.12.009" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1819" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:148-54" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 83 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 65 "PDF" => 14 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Clinical Research at Territorial Section Meetings of the Spanish Academy of Dermatology and Venereology (AEDV)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "148" "paginaFinal" => "154" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La investigación clínica en las secciones territoriales de la Academia Española de Dermatología y Venereología (AEDV)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1295 "Ancho" => 2365 "Tamanyo" => 158732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Changes in the percentage of clinical research presented at dermatology conferences in 3 Spanish territories in the years studied. Gaps in the graphs correspond to years when an area did not hold a conference. ACCL refers to Asturias, Cantabria, and Castile-Leon.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Á. Iglesias-Puzas, A. Batalla, Á. Flórez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Á." "apellidos" => "Iglesias-Puzas" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Batalla" ] 2 => array:2 [ "nombre" => "Á." "apellidos" => "Flórez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305537" "doi" => "10.1016/j.ad.2017.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017305537?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017304225?idApp=UINPBA000044" "url" => "/15782190/0000010900000002/v1_201803020443/S1578219017304225/v1_201803020443/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Capillary Malformations Treated With Sequential Pulsed Dye and Nd:YAG Laser Therapy: A Retrospective Study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "155" "paginaFinal" => "161" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Alcántara-González, P. Boixeda, M.T. Truchuelo-Díez, N. Jiménez-Gómez, B. Pérez-García, L. Pérez-Carmona, P. Jaén Olasolo" "autores" => array:7 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Alcántara-González" "email" => array:1 [ 0 => "jalcantarag@hotmail.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Boixeda" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "M.T." "apellidos" => "Truchuelo-Díez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "N." "apellidos" => "Jiménez-Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "B." "apellidos" => "Pérez-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "L." "apellidos" => "Pérez-Carmona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "P." "apellidos" => "Jaén Olasolo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad de Alcalá, Alcalá de Henares, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Malformaciones capilares tratadas con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1435 "Ancho" => 2206 "Tamanyo" => 490973 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A, Violaceous capillary malformation without associated hypertrophy. B, Marked improvement after 3 treatment sessions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Capillary or venular malformations occur in approximately 0.1% to 2% of newborn infants and are the most common type of vascular malformations.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> They can be found on any body part but occur most frequently on the head and neck.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Capillary malformations present as pink patches that tend to darken with age, acquiring a violaceous color and a pebbly appearance. They can also be associated with hypertrophy of the soft tissues and underlying bone.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The current treatment of choice for capillary malformations is pulsed dye laser (PDL) therapy, but in many patients this is ineffective or achieves only partial improvement. The search for alternative treatment strategies thus continues.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Good results have been achieved with other types of laser therapy, including Nd:YAG<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2–4</span></a> and alexandrite.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5–8</span></a> Nd:YAG and alexandrite lasers both achieve greater penetration than PDL, which is one reason why hypertrophic lesions tend to respond better to these treatment options. Other light sources, such as intense pulsed light therapy,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">9–15</span></a> have also been used, as well as laser therapy combined with antiangiogenic drugs.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> Photodynamic therapy also appears to be effective.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this study, we describe our experience with the treatment of capillary malformations using dual-wavelength sequential pulses from a PDL and a Nd:YAG laser (Cynergy Multiplex, Cynosure, Inc., Westford, MA, United States).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study Population</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a retrospective, descriptive study of patients with capillary malformations treated with dual-wavelength PDL and Nd:YAG laser therapy in the laser therapy unit of Hospital Ramón y Cajal between 2006 and 2011. Patients with an incomplete clinical history or insufficient photographic documentation were excluded.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In order to identify factors that might have influenced the response to therapy, we collected the following data on each patient: sex, color of lesion (red, pink, or violaceous), associated soft-tissue hypertrophy, and size of lesion (maximum diameter <3<span class="elsevierStyleHsp" style=""></span>cm, 3-10<span class="elsevierStyleHsp" style=""></span>cm, or >10<span class="elsevierStyleHsp" style=""></span>cm).</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure</span><p id="par0040" class="elsevierStylePara elsevierViewall">The patients or their guardians were informed of the likely benefits, risks, and potential complications of the treatment and the available alternatives. Written informed consent was obtained before treatment was started.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Anesthesia was used in some cases, depending on the size and site of the lesion and the age and tolerance of each patient. In cases in which anesthesia was indicated, the options used were anesthetic cream containing lidocaine and prilocaine (Eutectic Mixture of Local Anesthetics [EMLA], AstraZeneca, Wedel, Germany) applied under occlusion 2<span class="elsevierStyleHsp" style=""></span>hours before each session or general anesthesia administered under the supervision of the anesthesiology department.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The parameters for the sequential dual-wavelength pulses from a 595<span class="elsevierStyleHsp" style=""></span>nm PDL and a 1064<span class="elsevierStyleHsp" style=""></span>nm Nd:YAG laser were as follows: with a 10<span class="elsevierStyleHsp" style=""></span>mm spot size, a 10<span class="elsevierStyleHsp" style=""></span>ms pulse with a PDL at a fluence of 6<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>, a 1 second delay, followed by a 15<span class="elsevierStyleHsp" style=""></span>ms pulse with a Nd:YAG laser at a fluence of 30-60<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>; or, with a 7<span class="elsevierStyleHsp" style=""></span>mm spot size, a 10<span class="elsevierStyleHsp" style=""></span>ms pulse with a PDL at a fluence of 6<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>, a 1 second delay, followed by a 15<span class="elsevierStyleHsp" style=""></span>ms pulse with a Nd:YAG laser at a fluence of 30-80<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>. Patients attended treatment sessions approximately once every 6 months.</p><p id="par0055" class="elsevierStylePara elsevierViewall">A forced-air cooling device (Cryo 5, Zimmer MedizinSysteme GmbH, Neu-Ulm, Germany) set to its highest fan speed (6) was used throughout the treatment. In patients with larger malformations and a marked hypertrophic component, ice was also applied immediately after the treatment.</p><p id="par0060" class="elsevierStylePara elsevierViewall">For posttreatment care, patients were instructed to apply a topical antibiotic cream (fusidic acid, Fucidine, LEO Pharma, Barcelona, Spain) once daily for approximately 1 week and to avoid exposure to sunlight and use sunscreen with a sun protection factor of 50 or higher for at least 2 months after each treatment session.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Assessment</span><p id="par0065" class="elsevierStylePara elsevierViewall">We used a visual scale based on photographs taken before the first treatment session and at least 1 month after the last session. Taking into account skin color and texture and lesion height, 4 dermatologists evaluated the effectiveness of the treatment on a scale of 10 to 0, where 10 was the original pretreatment lesion and 0 was completely normal skin. Each patient's improvement was calculated as the mean of those 4 scores.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Patient photographs and medical histories were searched for evidence of adverse effects.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical Analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">For each variable studied and in the analysis of each subgroup, data were checked for normal distribution with the Kolmogorov-Smirnov goodness-of-fit test and the normality of the sample was confirmed.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Mean and standard deviation were the descriptive measures used for the quantitative variables and percentages were used for the qualitative variables.</p><p id="par0085" class="elsevierStylePara elsevierViewall">For the quantitative variables, the paired <span class="elsevierStyleItalic">t</span> test was used to analyze paired data.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">t</span> test or the analysis of variance were used to analyze unpaired data, depending on the number of variables being studied. When significant differences were found between a group of 3 or more variables, the Scheffe test was subsequently used to determine whether differences existed between the means of any groups.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In all cases, statistical significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Agreement between observers was assessed with the intraclass correlation coefficient.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">Seventy-one patients—37 male (52.11%) and 34 female (47.89%)—were included in the study. The patients were between the ages of 8 and 76 years at the start of treatment, and the mean (SD) age was 39.25 (15.00) years.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nineteen patients (26.76%) had pink lesions, 29 (40.85%) had red lesions, and 23 (32.39%) had violaceous lesions. Soft-tissue hypertrophy associated with the lesion was present in 38 patients (53.52%).</p><p id="par0115" class="elsevierStylePara elsevierViewall">The maximum lesion diameter was <3<span class="elsevierStyleHsp" style=""></span>cm in 6 patients (8.45%), 3-10<span class="elsevierStyleHsp" style=""></span>cm in 21 patients (29.58%), and >10<span class="elsevierStyleHsp" style=""></span>cm in 44 patients (61.97%).</p><p id="par0120" class="elsevierStylePara elsevierViewall">No previous treatment had been administered in 18.31% of the patients, whereas 81.69% of the patients had been treated at least once. Of the patients who had received treatment, 98.28% had been treated with PDL, 18.97% with carbon dioxide laser, 10.34% with diode laser, 3.45% with Nd:YAG laser and electrocoagulation, and 1.72% with alexandrite laser, argon laser, intense pulsed light, surgery, and radiation therapy.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The number of laser treatment sessions per patient ranged from 1 to 15, and the mean (SD) number of sessions was 5.18 (3.17).</p><p id="par0130" class="elsevierStylePara elsevierViewall">The intraclass correlation coefficient among the 4 evaluators was 0.947 (95% CI, 0.923-0.964), indicating very good, statistically significant agreement.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The difference between the pretreatment and posttreatment values for the entire group of patients was statistically significant (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) and the mean improvement was 4.59 points (95% CI, 3.97-5.20).</p><p id="par0140" class="elsevierStylePara elsevierViewall">The mean (SD) improvement was 4.93 (2.88) in female patients and 5.86 (2.29) in male patients, without statistically significant differences between the groups (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.13).</p><p id="par0145" class="elsevierStylePara elsevierViewall">As for lesion color, the mean (SD) improvement was 6.05 (2.81) for pink lesions, 6.38 (2.36) for red lesions, and 3.66 (1.82) for violaceous lesions. Statistically significant differences were found, respectively, between the groups with violaceous and pink malformations (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006) and between the groups with violaceous and red malformations (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), but not between the groups with pink and red malformations (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.89).</p><p id="par0150" class="elsevierStylePara elsevierViewall">Greater mean (SD) improvement was observed in patients with hypertrophy (4.57 [2.25]) than in patients without hypertrophy (6.38 [2.68]), and the difference between the groups was statistically significant (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003).</p><p id="par0155" class="elsevierStylePara elsevierViewall">As for lesion size, the mean (SD) improvement was 2.88 (2.21) in patients with lesions measuring <3<span class="elsevierStyleHsp" style=""></span>cm, 5.25 (2.58) in patients with lesions measuring 3-10<span class="elsevierStyleHsp" style=""></span>cm, and 5.84 (2.51) in patients with lesions measuring >10<span class="elsevierStyleHsp" style=""></span>cm. There were statistically significant differences between patients with malformations measuring <3<span class="elsevierStyleHsp" style=""></span>cm and those with lesions measuring >10<span class="elsevierStyleHsp" style=""></span>cm (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03); no statistically significant differences were found between patients with lesions measuring <3<span class="elsevierStyleHsp" style=""></span>cm and those with lesions measuring 3-10<span class="elsevierStyleHsp" style=""></span>cm (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.13) nor between the latter group and patients with malformations measuring >10<span class="elsevierStyleHsp" style=""></span>cm (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.68).</p><p id="par0160" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the statistical results.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Adverse effects were seen in 19 patients (26.76%), the most frequent (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13, 18.31%) being skin atrophy—usually mild—in certain areas. Skin atrophy throughout the treated area occurred in 2 patients (2.82%), transient crusting after some treatment sessions in 2 patients (2.82%), pigmentary changes, generally transient, in 3 patients (4.22%), and focal ulceration after some treatment sessions in 1 patient (1.41%).</p><p id="par0170" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1-3</a> show the responses achieved in some of the patients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">In the years since Anderson and Parrish proposed the theory of selective photothermolysis, PDL has become the first-line option for treating capillary malformations.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a> However, complete lesion clearance is only achieved in approximately 20% of patients treated with PDL, while 20-30% of patients see little or no improvement.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">There are various reasons why PDL is unable to completely destroy the ectatic capillaries of these lesions, including insufficient penetration, chromophore scarcity in the capillaries of small-caliber vessels, limited pulse duration, the use of inadequate fluence, and posttreatment revascularization and neoangiogenesis.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Because of these disadvantages, various alternatives have been used, including other light sources such as the Nd:YAG laser, which has been used successfully to treat capillary malformations with a marked hypertrophic component,<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2–4</span></a> although adverse effects are more common with Nd:YAG laser than with PDL.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Sequential application of a 595<span class="elsevierStyleHsp" style=""></span>nm PDL followed by a 1064<span class="elsevierStyleHsp" style=""></span>nm Nd:YAG laser has been shown to be effective at treating venous malformations,<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> angiolymphoid hyperplasia with eosinophilia,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a> and infantile hemangiomas.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> The response obtained with sequential application is due to the fact that PDL and Nd:YAG lasers have a depth of penetration of approximately 1<span class="elsevierStyleHsp" style=""></span>mm and 5-6<span class="elsevierStyleHsp" style=""></span>mm, respectively, and therefore reach structures at different dermal layers. Furthermore, PDL is used first. This reduces the oxygenated hemoglobin in the red blood cells to methemoglobin, causing a 3-fold to 5-fold increase in hemoglobin absorption by the Nd:YAG laser and making it possible to set the Nd:YAG laser at a lower fluence, thereby reducing the associated pain and edema.<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">23–25</span></a> This approach can theoretically reduce the adverse effects associated with the use of Nd:YAG lasers as monotherapy because higher fluences could increase the risk of atrophy and unattractive scarring associated with the loss of vascular selectivity.</p><p id="par0195" class="elsevierStylePara elsevierViewall">In our study, we treated 71 patients with dual-wavelength pulses from a PDL and a Nd:YAG laser; most had previously been treated with other therapies until no further clearance could be obtained.</p><p id="par0200" class="elsevierStylePara elsevierViewall">In our series, statistically significant improvement after treatment was achieved in the entire group of patients. Furthermore, we identified several predictors of better treatment response. Violaceous lesions had a significantly better response, and the presence of hypertrophy was also associated with greater improvement. Finally, lesions with a maximum diameter of <3<span class="elsevierStyleHsp" style=""></span>cm responded better to treatment than lesions measuring >10<span class="elsevierStyleHsp" style=""></span>cm.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Adverse effects occurred with moderate frequency (25.76%). In most cases, these effects were mild, the most common being mild skin atrophy in certain areas. However, we believe that this is an acceptable risk because most of these patients had not responded to other therapies and the overall result—taking into account improvement as well as adverse effects—was favorable.</p><p id="par0210" class="elsevierStylePara elsevierViewall">In the literature reviewed, we found only 1 study similar to ours.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> In that study, dual-wavelength PDL and Nd:YAG laser therapy was used to treat 25 patients with hypertrophic capillary malformations that were refractory to treatment with PDL. Moderate improvement was seen in 12 patients and slight improvement in 13 patients. Adverse effects included mild purpura (which is nearly inevitable after effective treatment) and, in 1 patient, the formation of vesicles, which resolved in 6 days without sequelae.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Although that study used a different assessment system and is therefore difficult to compare with our study, we believe that our results are slightly more promising. It is important to note that the other study included patients with capillary malformations that were either hypertrophic or refractory to PDL, whereas our study was limited to patients with hypertrophic capillary malformations and included some patients who had not been treated previously. However, we do not believe that the possibly greater degree of clearance achieved in our study can be attributed exclusively to this difference, since patients with hypertrophic malformations had the best response in our study. It is possible that there were slight differences in the parameters used for each patient and that each physician's experience may have played a role in this.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Our study had various limitations, including those typical of a retrospective, uncontrolled study. It is also possible that the efficacy of the treatment may have been influenced by certain variables not analyzed in this study: age, number of sessions, history of previous treatment, and use of topical anesthesia (although, on the basis of our experience and previous findings, we do not believe that this last factor alters efficacy).<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">27,28</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">We therefore consider that dual-wavelength sequential pulses from a PDL and a Nd:YAG laser is effective at treating capillary malformations. Despite not being considered the treatment of choice, this option could be considered in certain patients with lesions that are refractory to the usual treatment. It would be interesting to carry out a comparative study with Nd:YAG laser monotherapy in order to determine which treatment has a better efficacy and safety profile.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical Disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of persons and animals</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed complied with the ethical standards of the corresponding human experimentation committee and the World Medical Association and with the principles of the Declaration of Helsinki.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Data confidentiality</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that they followed their hospital's regulations regarding the publication of patient information.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors obtained informed consent from the patients and/or subjects referred to in this article. This document is in the possession of the corresponding author.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of Interest</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres994303" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec957560" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres994302" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec957561" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study Population" ] ] ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Procedure" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Assessment" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical Analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 9 => array:3 [ "identificador" => "sec0045" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of persons and animals" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-04-22" "fechaAceptado" => "2017-10-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec957560" "palabras" => array:5 [ 0 => "Sequential dual-wavelength" 1 => "Capillary malformation" 2 => "Pulsed dye laser" 3 => "Nd:YAG laser" 4 => "Laser treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec957561" "palabras" => array:5 [ 0 => "Doble longitud de onda secuencial" 1 => "Malformación capilar" 2 => "Láser de colorante pulsado" 3 => "Láser de Nd:YAG" 4 => "Tratamiento láser" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Capillary malformations are the most common vascular malformations in childhood. The current treatment of choice is pulsed dye laser (PDL) therapy, but this frequently does not result in complete resolution. The search for alternative treatment strategies thus continues. In this study we describe our experience with the use of sequential dual-wavelength PDL and Nd:YAG laser therapy in patients with capillary malformations.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted a retrospective, descriptive study of patients with capillary malformations treated with dual-wavelength PDL and Nd:YAG laser therapy between 2006 and 2011. Four dermatologists rated the effectiveness of treatment on a scale of 10 to 0. We also investigated the potential value of the following factors as predictors of better treatment response: sex, malformation size and color, and presence of associated hypertrophy. Adverse effects were also analyzed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We studied 71 patients and most of them experienced a statistically significant improvement after treatment. More favorable responses were observed for violaceous malformations, lesions with associated hypertrophy, and smaller lesions. Adverse effects were reported for 26.76% of patients, and the most common effect was the appearance of isolated areas of skin atrophy.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We consider that sequential dual-wavelength PDL and ND:YAG laser therapy is an effective alternative for treating capillary malformations in selected patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las malformaciones capilares son las malformaciones vasculares más frecuentes en la infancia. El tratamiento de elección sigue siendo el láser de colorante pulsado (LCP), sin embargo, la resolución completa con este habitualmente no se consigue, motivo por el que se siguen buscando otras alternativas terapéuticas. En este estudio comunicamos nuestra experiencia con el láser dual secuencial de LCP y Nd:YAG.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se efectuó un estudio retrospectivo y descriptivo de los pacientes con malformaciones capilares tratados con el láser dual de LCP y Nd:YAG desde 2006 hasta 2011. Cuatro dermatólogos valoraron el grado de eficacia en una escala del 10 al 0. Se analizó la posibilidad de factores predictores de mejor respuesta al tratamiento: sexo, color de la lesión, existencia de hipertrofia asociada y tamaño de la malformación. Se recogieron igualmente los efectos secundarios.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 71 pacientes, presentando el conjunto de ellos una mejoría estadísticamente significativa tras el tratamiento. Las malformaciones de coloración violácea que tenían hipertrofia asociada y las de menor tamaño se asociaron con una mejor respuesta. Se produjeron efectos adversos en un 26,76% de los pacientes, siendo la presencia de zonas atróficas puntuales el más frecuente.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Consideramos que el láser dual de LCP y Nd:YAG es una alternativa eficaz para el tratamiento de malformaciones capilares en paciente seleccionados.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alcántara-González J, Boixeda P, Truchuelo-Díez MT, Jiménez-Gómez N, Pérez-García B, Pérez-Carmona L, et al. Malformaciones capilares tratadas con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo. Actas Dermosifiliogr. 2018;109:155–161.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1435 "Ancho" => 2206 "Tamanyo" => 490973 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A, Violaceous capillary malformation without associated hypertrophy. B, Marked improvement after 3 treatment sessions.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1067 "Ancho" => 2225 "Tamanyo" => 360974 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A, Violaceous capillary malformation with associated soft-tissue hypertrophy. B, Improvement achieved after 3 treatment sessions.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 971 "Ancho" => 2201 "Tamanyo" => 417072 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A, Red capillary malformation without associated hypertrophy. B, Partial clearance after 4 treatment sessions.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study Group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Standard Deviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> Value Between Groups \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients before treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top"><<span class="elsevierStyleHsp" style=""></span>0.001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients after treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.61 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male patients (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">0.13</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female patients (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Without hypertrophy (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">0.003</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">With hypertrophy (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Red lesions (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top"><<span class="elsevierStyleHsp" style=""></span>0.001</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pink lesions (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Violaceous lesions (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lesions measuring <3<span class="elsevierStyleHsp" style=""></span>cm (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">0.02</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lesions measuring 3-10<span class="elsevierStyleHsp" style=""></span>cm (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lesions measuring >10<span class="elsevierStyleHsp" style=""></span>cm (after treatment) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1685887.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mean, Standard Deviation, and <span class="elsevierStyleItalic">P</span> Value Between Study Groups.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0145" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumores benignos de la infancia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. Azaña" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Dermatología en pediatría general" "paginaInicial" => "469" "paginaFinal" => "490" "serieFecha" => "2007" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0150" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-pulsed neodymium:yttrium-aluminum-garnet laser treatment for hypertrophic port-wine stains on the lips" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Kono" 1 => "W. Frederick Groff" 2 => "H.H. Chan" 3 => "H. Sakurai" 4 => "T. Yamaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/14764170802307940" "Revista" => array:6 [ "tituloSerie" => "J Cosmet Laser Ther." "fecha" => "2009" "volumen" => "11" "paginaInicial" => "11" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18830868" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0155" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment using a long pulsed Nd:YAG laser with a pulsed dye laser for four cases of blebbed port wine stains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.S. Chang" 1 => "Y.G. Kim" 2 => "J.H. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5021/ad.2011.23.S1.S75" "Revista" => array:7 [ "tituloSerie" => "Ann Dermatol." "fecha" => "2011" "volumen" => "23" "numero" => "Suppl 1" "paginaInicial" => "S75" "paginaFinal" => "S78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22028579" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0160" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-pulsed 1064<span class="elsevierStyleHsp" style=""></span>nm Nd:YAG laser improves hypertrophic port-wine stains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.M. Van Drooge" 1 => "B. Bosveld" 2 => "J.P. van der Veen" 3 => "M.A. de Rie" 4 => "A. Wolkerstorfer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.12021" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol." "fecha" => "2013" "volumen" => "27" "paginaInicial" => "1381" "paginaFinal" => "1386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23094931" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0165" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of hypertrophic and resistant port wine stains with a 755<span class="elsevierStyleHsp" style=""></span>nm laser: A case series of 20 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Izikson" 1 => "J.S. Nelson" 2 => "R.R. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lsm.20793" "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med." "fecha" => "2009" "volumen" => "41" "paginaInicial" => "427" "paginaFinal" => "432" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19588532" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0170" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment endpoints for resistant port wine stains with a 755<span class="elsevierStyleHsp" style=""></span>nm laser" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Izikson" 1 => "R.R. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/14764170802524452" "Revista" => array:6 [ "tituloSerie" => "J Cosmet Laser Ther." "fecha" => "2009" "volumen" => "11" "paginaInicial" => "52" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19012069" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0175" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alexandrite laser for the treatment of port wine stains refractory to pulsed dye laser" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.P. Tierney" 1 => "C.W. Hanke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2011.02079.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg." "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1268" "paginaFinal" => "1278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22988989" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0180" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison study of a long-pulse pulsed dye laser and a long-pulse pulsed alexandrite laser in the treatment of port wine stains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Li" 1 => "T. Kono" 2 => "W.F. Groff" 3 => "H.H. Chan" 4 => "Y. Kitazawa" 5 => "M. Nozaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/14764170701817023" "Revista" => array:6 [ "tituloSerie" => "J Cosmet Laser Ther." "fecha" => "2008" "volumen" => "10" "paginaInicial" => "12" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18330793" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0185" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of adult port-wine stains using intense pulsed light therapy (PhotoDerm VL): Brief initial clinical report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Raulin" 1 => "M.P. Goldman" 2 => "M.A. Weiss" 3 => "R.A. Weiss" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg." "fecha" => "1997" "volumen" => "23" "paginaInicial" => "594" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9236881" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0190" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of port-wine stains with a noncoherent pulsed light source: A retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Raulin" 1 => "C.A. Schroeter" 2 => "R.A. Weiss" 3 => "M. Keiner" 4 => "S. Werner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol." "fecha" => "1999" "volumen" => "135" "paginaInicial" => "679" "paginaFinal" => "683" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10376695" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0195" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of port wine stains with intense pulsed light: A prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.S. Ho" 1 => "S.Y. Ying" 2 => "P.C. Chan" 3 => "H.H. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2004.30260.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg." "fecha" => "2004" "volumen" => "30" "paginaInicial" => "887" "paginaFinal" => "890" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15171767" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0200" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of facial port-wine stains with intense pulsed light: A prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Ozdemir" 1 => "B. Engin" 2 => "I. Mevlitoğlu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1473-2165.2008.00375.x" "Revista" => array:6 [ "tituloSerie" => "J Cosmet Dermatol." "fecha" => "2008" "volumen" => "7" "paginaInicial" => "127" "paginaFinal" => "131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18482016" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0205" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulsed dye laser vs intense pulsed light for port-wine stains: A randomized side-by-side trial with blinded response evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Faurschou" 1 => "K. Togsverd-Bo" 2 => "C. Zachariae" 3 => "M. Haedersdal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2008.08993.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol." "fecha" => "2009" "volumen" => "160" "paginaInicial" => "359" "paginaFinal" => "364" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19120324" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0210" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Split-face comparison of intense pulsed light with short- and long-pulsed dye lasers for the treatment of port-wine stains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Babilas" 1 => "S. Schreml" 2 => "T. Eames" 3 => "U. Hohenleutner" 4 => "R.M. Szeimies" 5 => "M. Landthaler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lsm.20964" "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med." "fecha" => "2010" "volumen" => "42" "paginaInicial" => "720" "paginaFinal" => "727" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20886506" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0215" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulsed dye laser vs intense pulsed light for port-wine stains: A randomized side-by-side trial with blinded response evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Faurschou" 1 => "K. Togsverd-Bo" 2 => "C. Zachariae" 3 => "M. Haedersdal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2008.08993.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol." "fecha" => "2009" "volumen" => "160" "paginaInicial" => "359" "paginaFinal" => "364" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19120324" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0220" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Topical rapamycin combined with pulsed dye laser in the treatment of capillary vascular malformations in Sturge-Weber syndrome: Phase II, randomized, double-blind, intraindividual placebo-controlled clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Marqués" 1 => "J.M. Núñez-Córdoba" 2 => "L. Aguado" 3 => "M. Pretel" 4 => "P. Boixeda" 5 => "E. Nagore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.10.011" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2015" "volumen" => "72" "paginaInicial" => "151" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25455610" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0225" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Twenty years of clinical experience with a new modality of vascular-targeted photodynamic therapy for port wine stains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Qiu" 1 => "Y. Gu" 2 => "Y. Wang" 3 => "N. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2011.02129.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg." "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1603" "paginaFinal" => "1610" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21883647" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0230" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microvasculature can be selectively damaged using dye lasers: A basic theory and experimental evidence in human skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.R. Anderson" 1 => "J.A. Parrish" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med." "fecha" => "1981" "volumen" => "1" "paginaInicial" => "263" "paginaFinal" => "276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7341895" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0235" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of pulsed dye laser-resistant port wine stain birthmarks" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Z.F. Jasim" 1 => "J.M. Handley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2007.01.019" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2007" "volumen" => "57" "paginaInicial" => "677" "paginaFinal" => "682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17658196" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0240" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous malformations treated with dual wavelength 595 and 1064<span class="elsevierStyleHsp" style=""></span>nm laser system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Alcántara-González" 1 => "P. Boixeda" 2 => "B. Pérez-García" 3 => "M.T. Truchuelo-Díez" 4 => "P. González-Muñoz" 5 => "P. Jaén-Olasolo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2012.04548.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol." "fecha" => "2013" "volumen" => "27" "paginaInicial" => "727" "paginaFinal" => "733" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22540234" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0245" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiolymphoid hyperplasia with eosinophilia treated with vascular laser" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Alcántara González" 1 => "P. Boixeda" 2 => "M.T. Truchuelo Díez" 3 => "B. Pérez García" 4 => "P. Jaén Olasolo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10103-011-0892-3" "Revista" => array:6 [ "tituloSerie" => "Lasers Med Sci." "fecha" => "2011" "volumen" => "26" "paginaInicial" => "285" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21347722" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0250" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infantile hemangiomas treated by sequential application of pulsed dye laser and Nd:YAG laser radiation: A retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Alcántara-González" 1 => "P. Boixeda" 2 => "M.T. Truchuelo-Díez" 3 => "B. Pérez-García" 4 => "L. Alonso-Castro" 5 => "P. Jaén Olasolo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2012.12.010" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2013" "volumen" => "104" "paginaInicial" => "504" "paginaFinal" => "511" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23522740" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0255" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of resistant port-wine stains with a pulsed dual wavelength 595 and 1064<span class="elsevierStyleHsp" style=""></span>nm laser: A histochemical evaluation of the vessel wall destruction and selectivity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Borges da Costa" 1 => "P. Boixeda" 2 => "C. Moreno" 3 => "J. Santiago" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/pho.2008.2356" "Revista" => array:6 [ "tituloSerie" => "Photomed Laser Surg." "fecha" => "2009" "volumen" => "27" "paginaInicial" => "599" "paginaFinal" => "605" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19558312" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0260" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methemoglobin formation during laser induced photothermolysis of vascular skin lesion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.L. Randeberg" 1 => "J.H. Bonesrønning" 2 => "M. Dalaker" 3 => "J.S. Nelson" 4 => "L.O. Svaasand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lsm.20042" "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med" "fecha" => "2004" "volumen" => "34" "paginaInicial" => "414" "paginaFinal" => "419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15216535" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0265" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanistic comparison of blood undergoing laser photocoagulation at 532 and 1,064<span class="elsevierStyleHsp" style=""></span>nm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.F. Black" 1 => "N. Wade" 2 => "J.K. Barton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lsm.20134" "Revista" => array:6 [ "tituloSerie" => "Lasers Surg Med" "fecha" => "2005" "volumen" => "36" "paginaInicial" => "155" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15704164" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0270" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined 595-nm and 1,064-nm laser irradiation of recalcitrant and hypertrophic port-wine stains in children and adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.S. Alster" 1 => "E.L. Tanzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4725.2009.01155.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg." "fecha" => "2009" "volumen" => "35" "paginaInicial" => "914" "paginaFinal" => "918" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19397657" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0275" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulsed-dye laser treatment of port-wine stains in children: Useful tips to avoid general anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Alegre-Sánchez" 1 => "B. Pérez-García" 2 => "P. Boixeda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pde.13207" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol." "fecha" => "2017" "volumen" => "34" "paginaInicial" => "619" "paginaFinal" => "621" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28758247" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0280" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of the topical anesthetic EMLA on the efficacy of pulsed dye laser treatment of port-wine stains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Ashinoff" 1 => "R.G. Geronemus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Dermatol Surg Oncol." "fecha" => "1990" "volumen" => "16" "paginaInicial" => "1008" "paginaFinal" => "1011" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2246405" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000002/v1_201803020443/S1578219017304237/v1_201803020443/en/main.assets" "Apartado" => array:4 [ "identificador" => "6155" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000002/v1_201803020443/S1578219017304237/v1_201803020443/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017304237?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 5 | 13 |
| 2024 October | 74 | 41 | 115 |
| 2024 September | 60 | 28 | 88 |
| 2024 August | 123 | 62 | 185 |
| 2024 July | 111 | 34 | 145 |
| 2024 June | 82 | 38 | 120 |
| 2024 May | 63 | 25 | 88 |
| 2024 April | 82 | 27 | 109 |
| 2024 March | 67 | 31 | 98 |
| 2024 February | 65 | 33 | 98 |
| 2024 January | 49 | 35 | 84 |
| 2023 December | 45 | 26 | 71 |
| 2023 November | 60 | 38 | 98 |
| 2023 October | 54 | 43 | 97 |
| 2023 September | 71 | 39 | 110 |
| 2023 August | 64 | 18 | 82 |
| 2023 July | 81 | 54 | 135 |
| 2023 June | 83 | 46 | 129 |
| 2023 May | 79 | 32 | 111 |
| 2023 April | 74 | 30 | 104 |
| 2023 March | 97 | 27 | 124 |
| 2023 February | 87 | 22 | 109 |
| 2023 January | 64 | 45 | 109 |
| 2022 December | 70 | 44 | 114 |
| 2022 November | 46 | 29 | 75 |
| 2022 October | 54 | 33 | 87 |
| 2022 September | 38 | 41 | 79 |
| 2022 August | 31 | 38 | 69 |
| 2022 July | 34 | 34 | 68 |
| 2022 June | 39 | 38 | 77 |
| 2022 May | 50 | 36 | 86 |
| 2022 April | 109 | 49 | 158 |
| 2022 March | 81 | 60 | 141 |
| 2022 February | 68 | 34 | 102 |
| 2022 January | 80 | 52 | 132 |
| 2021 December | 78 | 56 | 134 |
| 2021 November | 68 | 55 | 123 |
| 2021 October | 81 | 62 | 143 |
| 2021 September | 68 | 64 | 132 |
| 2021 August | 56 | 52 | 108 |
| 2021 July | 47 | 39 | 86 |
| 2021 June | 55 | 41 | 96 |
| 2021 May | 53 | 64 | 117 |
| 2021 April | 131 | 115 | 246 |
| 2021 March | 65 | 41 | 106 |
| 2021 February | 103 | 51 | 154 |
| 2021 January | 51 | 29 | 80 |
| 2020 December | 56 | 36 | 92 |
| 2020 November | 38 | 36 | 74 |
| 2020 October | 41 | 16 | 57 |
| 2020 September | 62 | 31 | 93 |
| 2020 August | 38 | 30 | 68 |
| 2020 July | 49 | 33 | 82 |
| 2020 June | 48 | 37 | 85 |
| 2020 May | 24 | 19 | 43 |
| 2020 April | 32 | 16 | 48 |
| 2020 March | 32 | 14 | 46 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 2 | 0 | 2 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 10 | 0 | 10 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 8 | 0 | 8 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 5 | 0 | 5 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 2 | 0 | 2 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 7 | 10 | 17 |
| 2018 January | 9 | 11 | 20 |
Show all
