Indocyanine green-augmented diode laser treatment of port-wine stains: clinical and histological evidence for a new treatment option from a randomized controlled trial

• Published in: British journal of dermatology (1951) Vol. 167; no. 2; pp. 333 - 342
• Main Authors: Klein, A., Szeimies, R.-M., Bäumler, W., Zeman, F., Schreml, S., Hohenleutner, U., Landthaler, M., Koller, M., Babilas, P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2012; Wiley-Blackwell
• Subjects: Adolescent; Adult; Aged; Analysis of Variance; Biological and medical sciences; Dermatology; Feasibility Studies; Female; Hereditary diseases of the skin. Congenital diseases of the skin. Haemangioma of the skin, of mucosae and of soft tissue; Humans; Indocyanine Green - therapeutic use; Intraoperative Complications - etiology; Laser Therapy - adverse effects; Laser Therapy - methods; Lasers, Semiconductor - therapeutic use; Male; Medical sciences; Middle Aged; Pain - etiology; Patient Preference; Photosensitizing Agents - therapeutic use; Port-Wine Stain - pathology; Port-Wine Stain - surgery; Prospective Studies; Treatment Outcome; Young Adult; Vascular disease; Skin disease; Dermatology; Port wine stain; Cardiovascular disease; Indocyanine green; Congenital disease
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2012.10950.x

Summary Background  Complete clearance of port‐wine stains (PWS) is difficult to achieve, mainly because of the resistance of small blood vessels to laser irradiation. Indocyanine green (ICG)‐augmented diode laser treatment (ICG+DL) may overcome this problem. Objectives  To evaluate the feasibility of ICG+DL therapy of PWS and to compare the safety and efficacy of ICG+DL with the standard treatment, flashlamp‐pumped pulsed dye laser (FPDL). Methods  In a prospective randomized controlled clinical study, 31 patients with PWS were treated with FPDL (λem = 585 nm, 6 J cm−2, 0·45 ms pulse duration) and ICG+DL (λem = 810 nm, 20–50 J cm−2, 10–25 ms pulse duration, ICG‐concentration: 2 mg kg−1 body weight) in a split‐face modus in one single treatment setting that included histological examination (haematoxylin and eosin, CD34). Two blinded investigators and the patients assessed clearance rate, cosmetic appearance and side‐effects up to 3 months after treatment. Results  ICG+DL therapy induced photocoagulation of medium and large blood vessels (> 20 μm diameter) but not of small blood vessels. According to the investigators’ assessment, clearance rates and cosmetic appearance were better after ICG+DL therapy than after FPDL treatment (P = 0·114, P = 0·291, respectively), although not up to a statistically significant level, whereas patients considered these parameters superior (P = 0·003, P = 0·006, respectively). On a 10‐point scale indicating pain during treatment, patients rated ICG+DL to be more painful (5·81 ± 2·12) than FPDL treatment (1·61 ± 1·84). Conclusion  ICG+DL represents a new and promising treatment modality for PWS, but laser parameters and ICG concentration need to be further optimized.