title: Indocyanine green-augmented diode laser treatment of port-wine stains: clinical and histological evidence for a new treatment option from a randomized controlled trial.
abstract: 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.
  
  
  OBJECTIVE
  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 (λ(em)=585 nm, 6 J cm(-2) , 0.45 ms pulse duration) and ICG+DL (λ(em)=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).
  
  
  CONCLUSIONS
  ICG+DL represents a new and promising treatment modality for PWS, but laser parameters and ICG concentration need to be further optimized.
authors.affiliation: Department of Dermatology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Klein
authors.forename: R-M
authors.initials: RM
authors.lastname: Szeimies
authors.forename: W
authors.initials: W
authors.lastname: Bäumler
authors.forename: F
authors.initials: F
authors.lastname: Zeman
authors.forename: S
authors.initials: S
authors.lastname: Schreml
authors.forename: U
authors.initials: U
authors.lastname: Hohenleutner
authors.forename: M
authors.initials: M
authors.lastname: Landthaler
authors.forename: M
authors.initials: M
authors.lastname: Koller
authors.forename: P
authors.initials: P
authors.lastname: Babilas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000627:therapeutic use*; D007431:Intraoperative Complications / Q000209:etiology; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D057240:Patient Preference; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D019339:Port-Wine Stain / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017319:Photosensitizing Agents; D007208:Indocyanine Green