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.

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.

Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Figures

Figure 1

Port Wine Stain treated in the PDL + imiquimod group. Site 1 received imiquimod alone; site 2 received PDL + imiquimod; site 3 received PDL alone; and site 4 is an untreated PWS site. The Δa* for each site was: site 1 (imiquimod alone) =1.41; site 2 (PDL + imiquimod) =2.68; site 3 (PDL alone) =2.37; and site 4 (untreated PWS) = −1.63.