INDOCYANINE GREEN-AUGMENTED DIODE LASER TREATMENT OF PORT WINE STAINS: CLINICAL AND HISTOLOGICAL EVIDENCE FOR A NEW TREATMENT OPTION FROM A RANDOMIZED CONTROLLED TRIAL (RCT)

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 (lambda(em) = 585 nm, 6 J cm(-2), 0.45 ms pulse duration) and ICG+DL (lambda(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 mu m 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.