Original articles
Selectivity of Photothermolysis in the Treatment of Port Wine Stains Using Multiple Pulses With a Pulsed Dye Laser
Selectividad de la Fototermólisis en el Tratamiento de las Manchas en Vino de Oporto Mediante Múltiples Pulsos de Láser de Colorante Pulsado
I. Aldanondo
, P. Boixeda, M. Fernández-Lorente, A. Marquet, M. Calvo, P. Jaén
Autor para correspondencia
ialdanondo@yahoo.es
Correspondence: C/ José Lázaro Galdiano n.°1, esc A, 7.° dcha, 28036 Madrid, Spain.
Correspondence: C/ José Lázaro Galdiano n.°1, esc A, 7.° dcha, 28036 Madrid, Spain.
Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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"documento" => "simple-article" "crossmark" => 0 "subdocumento" => "err" "cita" => "Actas Dermosifiliogr. 2008;99:787" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2131 "formatos" => array:3 [ "EPUB" => 35 "HTML" => 1563 "PDF" => 533 ] ] "en" => array:6 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Errata</span>" "tienePdf" => "en" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "787" ] ] "contienePdf" => array:1 [ "en" => true ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219008703810?idApp=UINPBA000044" "url" => "/15782190/0000009900000010/v1_201304241444/S1578219008703810/v1_201304241444/en/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>" "titulo" => "Selectivity of Photothermolysis in the Treatment of Port Wine Stains Using Multiple Pulses With a Pulsed Dye Laser" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "546" "paginaFinal" => "554" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Aldanondo, P. Boixeda, M. Fernández-Lorente, A. Marquet, M. Calvo, P. Jaén" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Aldanondo" "email" => array:1 [ 0 => "ialdanondo@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Boixeda" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Fernández-Lorente" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Marquet" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Calvo" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Jaén" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondence: C/ José Lázaro Galdiano n.°1, esc A, 7.° dcha, 28036 Madrid, Spain." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Selectividad de la Fototermólisis en el Tratamiento de las Manchas en Vino de Oporto Mediante Múltiples Pulsos de Láser de Colorante Pulsado" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2008-01-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec84242" "palabras" => array:5 [ 0 => "port wine stain" 1 => "nevus flammeus" 2 => "capillary malformation" 3 => "pulsed dye laser" 4 => "multiple pulses" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84241" "palabras" => array:5 [ 0 => "mancha en vino de Oporto" 1 => "<span class="elsevierStyleItalic">nevus flammeus</span>" 2 => "malformación capilar" 3 => "láser de colorante pulsado" 4 => "multipulsos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p class="elsevierStyleSimplePara elsevierViewall">In 25% to 50% of patients with port wine stains treated with pulsed dye laser (even in multiple sessions), only a partial improvement is obtained that is often unsatisfactory for the patient. Various factors have been proposed to explain the resistance to treatment, such as the presence of deep, small-caliber, or very thick vessels that cannot be coagulated with a single laser pulse. Certain mathematical models suggest that multiple pulses would be effective in coagulating those vessels without losing the selectivity of photothermolysis, since more energy could be delivered to the target structures without damaging the surrounding tissue. The aim of this study was to assess the efficacy and selectivity of photothermolysis with multiple laser pulses.</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">Twelve patients with port wine stains were included in the study. Various areas of each lesion were treated with pulsed dye laser (Candela V-beam, 595<span class="elsevierStyleHsp" style=""></span>nm) using different parameters. Immediately afterwards, the treated areas were biopsied.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The risk of exceeding an appropriate dose was greater with small spot size, long pulse duration, short intervals between pulses, and high fluences. Heat damage was less with spots of 10<span class="elsevierStyleHsp" style=""></span>mm, short pulses, intervals of 1<span class="elsevierStyleHsp" style=""></span>minute between pulses, and low fluences. In selected cases, multiple pulses were effective and selective where single pulses did not successfully coagulate the vessels.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Our results indicate the enormous possibilities of multiple laser pulses for the treatment of refractory vascular lesions. In addition, we have addressed the variables defining the complex thermodynamic interaction between the laser and the cutaneous tissue and indicated the safest parameters. We discuss the possible usefulness of this approach with other lasers and skin diseases.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">En un 25-50% de los pacientes con manchas en vino de Oporto tratadas con láser de colorante pulsado (incluso con múltiples sesiones) obtenemos un resultado parcial y frecuentemente insatisfactorio para el paciente. Se han propuesto varios factores que explicarían esta resistencia al tratamiento, como la presencia de vasos profundos, de pequeño calibre o muy gruesos, a los que un solo pulso de láser no logra coagular. Existen modelos matemáticos que sugieren que los multipulsos serían eficaces para coagular estos vasos sin perder la selectividad de la fototermólisis, ya que permiten administrar más energía sobre las estructuras diana, sin lesionar el tejido circundante. El objetivo de este estudio es evaluar la eficacia y la selectividad de la fototermólisis al usar multipulsos.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron 12 pacientes con manchas en vino de Oporto. Se trataron varias zonas de cada lesión con láser de colorante pulsado (V-beam 595<span class="elsevierStyleHsp" style=""></span>nm, Candela<span class="elsevierStyleSup">®</span>) y distintos parámetros. Inmediatamente después se biopsiaron las zonas tratadas.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El riesgo de sobredosificar fue mayor con tamaños del haz pequeños, pulsos largos, intervalo breve entre pulsos y fluencias elevadas. El daño térmico fue menor con tamaños del haz de 10<span class="elsevierStyleHsp" style=""></span>mm, pulsos cortos, intervalo de 1<span class="elsevierStyleHsp" style=""></span>minuto entre los pulsos y fluencias bajas. En casos seleccionados, los multipulsos eran eficaces y selectivos, ahí donde el pulso único no lograba coagular los vasos.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados ponen de manifiesto las enormes posibilidades que los multipulsos ofrecen para el tratamiento de las lesiones vasculares refractarias. Asimismo, definimos los parámetros que intervienen en este complejo proceso termodinámico de interacción del láser con el tejido cutáneo, se señalan cuáles son más seguros y apuntamos su utilidad con otros láseres y patologías cutáneas.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulsed dye laser-resistant port-wine stains" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.S. Kane" 1 => "B.R. Smoller" 2 => "R.E. Fitzpatrick" 3 => "N.P. Walker" 4 => "J.S. 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