Characterization of port wine stain birthmarks

描述(由申请人提供)： 鲜红斑点(PWS)是一种先天性的进行性皮肤血管畸形。脉冲染料激光在有限的患者中产生了相当好的临床效果，因为它能够选择性地破坏PWS血管。然而，激光治疗后达到的漂白程度是可变的和不可预测的，如果所需的最终标准是完全漂白，平均治疗成功率低于10%。我们推测，这主要是因为主治医生不能为特定的PWS病变选择最佳的激光治疗参数。目前，所有患者都使用相似的激光参数进行治疗，根据医生的临床判断进行选择，而不考虑PWS几何形状或人体皮肤光学特性的个体差异。特别是，表皮厚度和黑色素吸收，以及PWS血管直径和深度分布因患者而异，甚至在同一患者的不同区域之间也是如此。需要一种合适的成像方式来研究个体PWS特征与不同治疗参数的治疗反应之间的关系。我们的长期目标是开发一种有针对性的方法，以个别患者为基础对接受激光治疗的PWS患者进行临床管理。PWS激光治疗的临床目标是最大限度地增加对靶血管的热损伤，同时避免表皮损伤。我们在这项研究提案中的中心假设是，红外线断层扫描(IRT)在激光治疗之前为PWS的特征提供了一种实用的方法。为了响应亚治疗性诊断激光脉冲，IRT提供了一种方法来确定PWS皮肤的初始空间相关温升，这将使主治医生能够为每个病变应用最佳治疗参数(光剂量、波长、脉冲持续时间和冷冻剂喷射持续时间)，从而避免表皮损伤，同时最大限度地破坏目标血管。总之，申请人认为，IRT的成功开发和实施应该会改善治疗结果，减少治疗次数，并提高PWS激光治疗的安全性。

DESCRIPTION (provided by applicant): Port wine stain (PWS) is a congenital, progressive vascular malformation of human skin. The pulsed dye laser produces reasonably good clinical results in a limited population of patients due to its ability to destroy selectively PWS blood vessels. However, the degree of blanching achieved following laser therapy is variable and unpredictable, with the average treatment success rate below 10% if the ultimate standard required is complete blanching of the lesion. We hypothesize that this occurs primarily because the attending physician is unable to select optimal laser treatment parameters for a specific PWS lesion. Presently, all patients are treated using similar laser parameters, with selection based on clinical judgment of the physician, without taking into consideration individual variations in PWS geometry or optical properties of human skin. In particular, epidermal thickness and melanin absorption, as well as PWS blood vessel diameter and depth distribution vary on an individual patient basis and even between different areas on the same patient. A suitable imaging modality is needed to enable studies of relationships between individual PWS characteristics and response to therapy with varied treatment parameters. Our long-term goal is to develop a targeted approach to the clinical management of PWS patients receiving laser therapy on an individual patient basis. The clinical objective of PWS laser therapy is to maximize thermal damage to targeted blood vessels, while avoiding epidermal injury. Our central hypothesis in this research proposal is that infrared tomography (IRT) provides a practical methodology for PWS characterization prior to institution of laser therapy. In response to a sub-therapeutic diagnostic laser pulse, IRT provides a means to determine the initial space-dependent temperature increase in PWS skin which will enable the attending physician to apply optimal treatment parameters (light dosage, wavelength, pulse duration, and cryogen spurt duration) for each lesion, thereby avoiding epidermal damage while at the same time maximizing destruction of targeted blood vessels. In summary, the applicants believe that successful development and implementation of IRT should improve therapeutic outcome, reduce the number of treatment sessions, and improve the safety of PWS laser therapy.