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Journal of the American Academy of Dermatology
Volume 66, n° 4
pages 634-641 (avril 2012)
Doi : 10.1016/j.jaad.2011.11.958
Dermatologic Surgery

Enhanced port-wine stain lightening achieved with combined treatment of selective photothermolysis and imiquimod
 

Anne Marie Tremaine, MD a, b, , Jennifer Armstrong, MS a, e, Yu-Chih Huang, PhD a, c, Leila Elkeeb, MD a, b, Arisa Ortiz, MD a, b, Ronald Harris, MD, MBA b, Bernard Choi, PhD a, d, Kristen M. Kelly, MD a, b
a Beckman Laser Institute, University of California, Irvine, Irvine, California 
b Department of Dermatology, University of California, Irvine, Irvine, California 
c Department of Electrical Engineering and Computer Science, University of California, Irvine, Irvine, California 
d Department of Biomedical Engineering, University of California, Irvine, Irvine, California 
e John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 

Reprint requests: Anne Marie Tremaine, MD, Department of Dermatology, University of California, Irvine, C340 Medical Sciences 1, Irvine, CA 92697-2400.
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 Lab 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.

Limitations

Effects were evaluated after a single treatment and duration of effect is unknown.

Conclusion

Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy.

The full text of this article is available in PDF format.

Key words : angiogenesis, imiquimod, port-wine stain, pulsed dye laser, selective photothermolysis, vascular malformation

Abbreviations used : bFGF, IL, MMP, PDL, PWS, VEGF



 Supported in part by grants from the American Society for Laser Medicine and Surgery (Dr Kelly), the National Institutes of Health (NIH) (AR51443 to Dr Kelly), the A. Ward Ford Foundation (Dr Choi), and Graceway Pharmaceuticals. Imiquimod and placebo cream were provided by Graceway Pharmaceuticals. Equipment was from Candela Corp. Institutional support was provided by the NIH Laser Microbeam and Medical Program (a P41 Technology Research Resource), NIH EB009571 (Dr Choi), and the Arnold and Mabel Beckman Foundation.
 Disclosure: Dr Kelly received grants from Graceway Pharmaceuticals, Candela Corp, DUSA. She also has relationships with Solta Medical (equipment and grants) and DUSA (equipment and grant). Drs Tremaine, Huang, Elkeeb, Ortiz, Harris, and Choi, and Ms Armstrong have no conflicts of interest to declare.



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