title: Enhanced port-wine stain lightening achieved with combined treatment of selective photothermolysis and imiquimod.
abstract: BACKGROUND
  Pulsed dye laser (PDL) is the gold standard for treatment of port-wine stain (PWS) birthmarks but multiple treatments are required and complete resolution is often not achieved. Posttreatment vessel recurrence is thought to be a factor that limits efficacy of PDL treatment of PWS. Imiquimod 5% cream is an immunomodulator with antiangiogenic effects.
  
  
  OBJECTIVE
  We sought to determine if application of imiquimod 5% cream after PDL improves treatment outcome.
  
  
  METHODS
  Healthy individuals with PWS (n = 24) were treated with PDL and then randomized to apply posttreatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements (Commission Internationale de l'Eclairage L∗a∗b∗ colorspace) for 57 PWS sites (multiple sites per patient) were taken at baseline and compared with measurements taken 8 weeks posttreatment. The Δa∗ (change in erythema) and ΔE (difference in color between normal-appearing skin and PWS skin) were measured to quantify treatment outcome.
  
  
  RESULTS
  Two patients developed minor skin irritation. Other adverse effects were not noted. Average ∆a∗ was 0.43 for PDL + placebo sites (n = 25) and 1.27 for PDL + imiquimod sites (n = 32) (P value = .0294) indicating a greater reduction in erythema with imiquimod. Average ∆E was 2.59 for PDL + placebo and 4.08 for PDL + imiquimod (P value = .0363), again indicating a greater color improvement with imiquimod.
  
  
  CONCLUSIONS
  Effects were evaluated after a single treatment and duration of effect is unknown.
  
  
  CONCLUSIONS
  Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy.
authors.affiliation: Beckman Laser Institute, University of California, Irvine, Irvine, California 92697-2400, USA. tremainea@hotmail.com
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Tremaine
authors.forename: Jennifer
authors.initials: J
authors.lastname: Armstrong
authors.forename: Yu-Chih
authors.initials: YC
authors.lastname: Huang
authors.forename: Leila
authors.initials: L
authors.lastname: Elkeeb
authors.forename: Arisa
authors.initials: A
authors.lastname: Ortiz
authors.forename: Ronald
authors.initials: R
authors.lastname: Harris
authors.forename: Bernard
authors.initials: B
authors.lastname: Choi
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Kelly
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000634:Aminoquinolines / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D000077271:Imiquimod; D054025:Lasers, Dye / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019339:Port-Wine Stain / Q000188:drug therapy* / Q000601:surgery*; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000077271:Imiquimod