Picosecond alexandrite laser treatment of nevus of Ota in children.

BACKGROUND: The picosecond alexandrite laser has been safely and effectively used to treat the nevus of Ota in adults. However, limited data are available for children. OBJECTIVE: To investigate the efficacy, safety, and correlative influencing factors of a 755nm picosecond alexandrite laser in the treatment of nevus of Ota in children. METHODS: We retrospectively analyzed Chinese children with nevus of Ota who received a 755nm picosecond alexandrite laser treatment in a tertiary dermatological hospital. RESULT: A total of 305 pediatric patients received an average of two treatments achieving an average of 79% pigment clearance. After the first treatment, 22 patients achieved complete clearance (95%-100%), and 72 patients achieved excellent response (75%-94%), with an average initial efficacy of 63% lesion clearance. Treatment at an early age achieved better initial efficacy (0- to 12-month group >1- to 6-year group, 6- to 12-year group). And 0- to 12-month group achieved better final efficacy. More treatment sessions also increased the final efficacy. Both initial efficacy and final efficacy were better when treating a darker lesion. The incidence of complications was 12.1%, with 10.8% being post-inflammatory hyperpigmentation and 1.3% being hypopigmentation. The rate of recurrence was 6.6%. LIMITATION: Retrospective study. CONCLUSION: A 755nm picosecond alexandrite laser is safe and effective in treating nevus of Ota in children. Younger to initiate treatment, darker lesions, and more treatments are positively associated with better pigmentation clearance.

HAPLN1 knockdown inhibits heart failure development via activating the PKA signaling pathway.

BACKGROUND: Heart failure (HF) is a heterogeneous syndrome that affects millions worldwide, resulting in substantial health and economic burdens. However, the molecular mechanism of HF pathogenesis remains unclear. METHODS: HF-related key genes were screened by a bioinformatics approach.The impacts of HAPLN1 knockdown on Angiotensin II (Ang II)-induced AC16 cells were assessed through a series of cell function experiments. Enzyme-linked immunosorbent assay (ELISA) was used to measure levels of oxidative stress and apoptosis-related factors. The HF rat model was induced by subcutaneous injection isoprenaline and histopathologic changes in the cardiac tissue were assessed by hematoxylin and eosin (HE) staining and echocardiographic index. Downstream pathways regulated by HAPLN1 was predicted through bioinformatics and then confirmed in vivo and in vitro by western blot. RESULTS: Six hub genes were screened, of which HAPLN1, FMOD, NPPB, NPPA, and COMP were overexpressed, whereas NPPC was downregulated in HF. Further research found that silencing HAPLN1 promoted cell viability and reduced apoptosis in Ang II-induced AC16 cells. HAPLN1 knockdown promoted left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS), while decreasing left ventricular end-systolic volume (LVESV) in the HF rat model. HAPLN1 knockdown promoted the levels of GSH and suppressed the levels of MDA, LDH, TNF-α, and IL-6. Mechanistically, silencing HAPLN1 activated the PKA pathway, which were confirmed both in vivo and in vitro. CONCLUSION: HAPLN1 knockdown inhibited the progression of HF by activating the PKA pathway, which may provide novel perspectives on the management of HF.

Comparison of the 1064-nm picosecond laser with fractionated microlens array and 1565-nm non-ablative fractional laser for the treatment of enlarged pores: a randomized, split-face, controlled trial.

PURPOSE: This split-face randomized study compared the efficacy and safety between 1064-nm picosecond laser with fractionated microlens array (MLA) and 1565-nm nonablative fractional laser to treat enlarged pores. METHODS: Participants with enlarged facial pores were enrolled and underwent three consecutive sessions at 2-week intervals with either a 1064-nm picosecond laser with MLA or a 1565-nm nonablative fractional laser. Images were captured at each visit. Objective (pore number) and subjective assessments, including patient self-evaluations and quartile improvement scales, were used to evaluate the treatment efficacy. The pain levels and adverse effects were recorded at each subsequent visit. RESULTS: The participants were 3 men and 22 women with enlarged facial pores. At the initial and 2-month checkups after the last treatment, the pore numbers were significantly decreased bilaterally for both lasers. The respective quartile improvement scale scores for the 1064-nm picosecond and 1565-nm fractional lasers were 2.22 ± 1.06 and 2.14 ± 1.11, while those for patient self-assessment were 3.72 ± 0.74 and 3.68 ± 0.75. The pore number, quartile improvement scale score, and patients' self-assessments did not differ significantly between the two lasers. Treatment with the 1064-nm picosecond laser better reduced pain compared with the 1565-nm nonablative fractional laser (4.11 ± 1.33 vs. 4.83 ± 1.17). The occurrence of pigmentation did not differ significantly between the lasers. CONCLUSION: Both the 1064-nm picosecond laser with MLA and the 1565-nm nonablative fractional laser are viable options for treating enlarged pores, and showed comparable respective efficacies; however, the former was less likely to cause hyperpigmentation and was better tolerated.

Life motion signals bias the perception of apparent motion direction.

Walking direction conveyed by biological motion (BM) cues, which humans are highly sensitive to since birth, can elicit involuntary shifts of attention to enhance the detection of static targets. Here, we demonstrated that such intrinsic sensitivity to walking direction could also modulate the direction perception of simultaneously presented dynamic stimuli. We showed that the perceived direction of apparent motion was biased towards the walking direction even though observers had been informed in advance that the walking direction of BM did not predict the apparent motion direction. In particular, rightward BM cues had an advantage over leftward BM cues in altering the perception of motion direction. Intriguingly, this perceptual bias disappeared when BM cues were shown inverted, or when the critical biological characteristics were removed from the cues. Critically, both the perceptual direction bias and the rightward advantage persisted even when only local BM cues were presented without any global configuration. Furthermore, the rightward advantage was found to be specific to social cues (i.e., BM), as it vanished when non-social cues (i.e., arrows) were utilized. Taken together, these findings support the existence of a specific processing mechanism for life motion signals and shed new light on their influences in a dynamic environment.

Life motion signals modulate visual working memory.

Previous research has demonstrated that biological motion (BM) cues can induce a reflexive attentional orienting effect, a phenomenon referred to as social attention. However, it remains undetermined whether BM cues can further affect higher-order cognitive processes, such as visual working memory (WM). By combining a modified central pre-cueing paradigm with a traditional WM change detection task, the current study investigated whether the walking direction of BM, as a non-predictive central cue, could modulate the encoding process of WM. Results revealed a significant improvement in WM performance for the items appearing at the location cued by the walking direction of BM. The observed effect disappeared when the BM cues were shown inverted, or when the critical biological characteristics of the cues were removed. Crucially, this effect could be extended to upright feet motion cues without global configuration, reflecting the key role of local BM signals in modulating WM. More importantly, such a BM-induced modulation effect was not observed with inanimate motion cues, although these cues can also elicit attentional effects. Our findings suggest that the attentional effect induced by life motion signals can penetrate to higher-order cognitive processes, and provide compelling evidence for the existence of "life motion detector" in the human brain from a high-level cognitive function perspective.

YTHDC1-Modified m6A Methylation of Hsa_circ_0102678 Promotes Keratinocyte Inflammation Induced by Cutibacterium acnes Biofilm through Regulating miR-146a/TRAF6 and IRAK1 Axis.

INTRODUCTION: CircRNAs are closely related to many human diseases; however, their role in acne remains unclear. This study aimed to determine the role of hsa_circ_0102678 in regulating inflammation of acne. METHODS: First, microarray analysis was performed to study the expression of circRNAs in acne. Subsequently, RNase R digestion assay and fluorescence in situ hybridization assay were utilized to confirm the characteristics of hsa_circ_0102678. Finally, qRT-PCR, Western blotting analysis, immunoprecipitation, luciferase reporter assay, circRNA probe pull-down assay, biotin-labeled miRNA pull-down assay, RNA immunoprecipitation assay, and m6A dot blot assay were utilized to reveal the functional roles of hsa_circ_0102678 on inflammation induced by C. acnes biofilm in human primary keratinocytes. RESULTS: Our investigations showed that the expression of hsa_circ_0102678 was significantly decreased in acne tissues, and hsa_circ_0102678 was a type of circRNAs, which was mainly localized in the cytoplasm of primary human keratinocytes. Moreover, hsa_circ_0102678 remarkably affected the expression of IL-8, IL-6, and TNF-α, which induced by C. acnes biofilm. Importantly, mechanistic studies indicated that the YTHDC1 could bind directly to hsa_circ_0102678 and promote the export of N6-methyladenosine-modified hsa_circ_0102678 to the cytoplasm. Besides, hsa_circ_0102678 could bind to miR-146a and sponge miR-146a to promote the expression of IRAK1 and TRAF6. CONCLUSION: Our findings revealed a previously unknown process by which hsa_circ_0102678 promoted keratinocyte inflammation induced by C. acnes biofilm via regulating miR-146a/TRAF6 and IRAK1 axis.

Comparison of the efficacy and safety of a 730 nm picosecond titanium sapphire laser and a 755 nm picosecond alexandrite laser for the treatment of freckles in Asian patients: A two-center randomized, split-face, controlled trial.

OBJECTIVE: The 730 nm picosecond titanium sapphire laser is a novel laser that shows promising results in treating freckles. This study aimed to further investigate the efficacy and safety of the 730 nm picosecond titanium sapphire laser for treating freckles in Asian patients compared with those of the 755 nm picosecond alexandrite laser. METHODS: Each face of 86 participants was split into two parts and randomly assigned either one session of 730 or 755 nm picosecond-laser treatment each. Efficacy and safety were determined based on blinded visual evaluations and self-reports at each follow-up visit. RESULTS: The treatment outcomes of the 730 nm picosecond laser for the treatment of freckles were comparable to those of the 755 nm picosecond laser, with 68.99 ± 7.42% and 69.27 ± 7.75% clearance, respectively (p > 0.05). Participants achieved similar Global Aesthetic Improvement Scale scores (4.04 ± 0.31 vs. 4.02 ± 0.30, respectively [p > 0.05]). Additionally, the 730 nm picosecond laser was perceived to be less painful than the 755 nm picosecond laser (4.69 ± 1.63 vs. 5.65 ± 1.80 nm, p < 0.0001). CONCLUSION: The 730 nm picosecond laser is safe and effective for the treatment of freckles in Asian patients. Besides, the 730 nm picosecond laser is less painful than the 755 nm picosecond laser.

Blue Nevus Hidden within the Nevus of Ota.

A 3-year-old boy presented with bluish patch and scattered blue spots on the left side of his face. After several sessions of laser treatment, the azury patch in the periorbital area became even darker. Histopathology showed many bipolar, pigment-laden dendritic cells scattered in the papillary and upper reticular dermis. Immunohistochemically, these cells were positive for S100, SOX-10, melan-A, P16, and HMB-45. The positive rate of Ki-67 was less than 5%. Finally, the lesion was diagnosed with nevus of Ota concurrent with common blue nevus. Therefore, for cases of the nevus of Ota with poor response to laser treatment, the possible coexisting diseases should be suspected.

Automatic identification of benign pigmented skin lesions from clinical images using deep convolutional neural network.

OBJECTIVE: We aimed to develop a computer-aided detection (CAD) system for accurate identification of benign pigmented skin lesions (PSLs) from images captured using a digital camera or a smart phone. METHODS: We collected a total of 12,836 clinical images which had been classified and location-labeled for training and validating. Four models were developed and validated; you only look once, v4 (YOLOv4), you only look once, v5 (YOLOv5), single shot multibox detector (SSD) and faster region-based convolutional neural networks (Faster R-CNN). The performance of the models was compared with three trained dermatologists, respectively. The accuracy of the best model was further tested and validated using smartphone-captured images. RESULTS: The accuracies of YOLOv4, YOLOv5, SSD and Faster R-CNN were 0.891, 0.929, 0.852 and 0.874, respectively. The precision, sensitivity and specificity of YOLOv5 (the best model) were 0.956, 0.962 and 0.952, respectively. The accuracy of YOLOv5 model for images captured using a smart-phone was 0.905. The CAD based YOLOv5 system can potentially be used in clinical identification of PSLs. CONCLUSION: We developed and validated a CAD system for automatic identification of benign PSLs using digital images. This approach may be used by non-dermatologists to easily diagnose by taking a photo of skin lesion and guide on management of PSLs.

A deep learning-based hybrid artificial intelligence model for the detection and severity assessment of vitiligo lesions.

Background: We aimed to establish and validate a deep learning-based hybrid artificial intelligence (AI) model for the objective morphometric and colorimetric assessment of vitiligo lesions. Methods: Two main datasets containing curated images of vitiligo lesions from Chinese patients (Fitzpatrick skin types III or IV) were established, including one with 2,720 images for lesion localization study and the other with 1,262 images for lesion segmentation study. Besides, an additional test set containing 145 images of vitiligo lesions from other Fitzpatrick skin types (I, II, or V) was also generated. A 3-stage hybrid model was constructed. YOLO v3 (You Only Look Once, v3) architecture was trained and validated to classify and localize vitiligo lesions, with sensitivity and error rate as primary performance outcomes. Then a segmentation study comparing 3 deep convolutional neural networks (DCNNs), Pyramid Scene Parsing Network (PSPNet), UNet, and UNet++, was carried out based on the Jaccard index (JI). The architecture with the best performance was integrated into the model. Three add-on metrics, namely VAreaA, VAreaR, and VColor were finally developed to measure absolute, relative size changes and pigmentation, respectively. Agreement between the AI model and dermatologist evaluators were assessed. Results: The sensitivity of the YOLO v3 architecture to detect vitiligo lesions was 92.91% with an error rate of 14.98%. The UNet++ architecture outperformed the others in the segmentation study (JI, 0.79) and was integrated into the model. On the additional test set, however, the model achieved a lower detection sensitivity (72.41%) and a lower segmentation score (JI, 0.69). With respect to size changes, no difference was observed between the AI model, trained dermatologists (W=0.812, P<0.05), and Photoshop analysis (P=0.075, P=0.212 respectively), which all displayed good concordance. Conclusions: We developed a novel, convenient, objective, and quantitative deep learning-based hybrid model which simultaneously evaluated both morphometric and colorimetric vitiligo lesions from patients with Fitzpatrick skin types III or IV, rendering it suitable for the assessment of severity of vitiligo lesions in Asians in both clinic and research scenarios. More work is also warranted for its use in other ethnic skin groups.

Treatment of acne scars with fractional carbon dioxide laser in Asians: a retrospective study to search for predicting factors associated with efficacy.

Ablative fractional laser treatment has been extensively used for resurfacing atrophic acne scars. However, few studies have investigated how the parameters set during laser procedures affect efficacy. In this retrospective study, we examined the relationship between efficacy and Fitzpatrick skin type, gender, age, follow-up duration, energy, and treatment sessions utilizing ablative fractional carbon dioxide (CO2) laser in Asians with Fitzpatrick skin types III-IV. We then analyzed the relationship between outcome and adverse effects including hyperpigmentation. Three blinded dermatologists used the ECCA (Echelle d'Evaluation Clinique des Cicatrices d'Acnluation Clinique des Cicospectively review 82 of 1034 patients who presented at our institution for atrophic acne scar treatment between August 2013 and August 2019. Factors associated with efficacy, including age, gender, Fitzpatrick skin type, energy, treatment sessions, follow-up duration, and pigmentation, were analyzed. 82 patients met inclusion criteria. Patients underwent one to three CO2 laser treatment sessions. Parameter settings for individual patients were consistent across treatments. Mean ECCA scores decreased from 102.70 ± 24.95 to 87.28 ± 24.48 (p ≤ 0.001). The number of treatment sessions and duration of pigmentation lasting shorter than 3 months positively correlated with better outcomes. All patients had erythema, which lasted longer than 3 months in 16 patients (19.51%). Post-inflammatory hyperpigmentation (PIH) affected 60 patients (73.17%) and lasted longer than 3 months in 26 patients (31.71%). One patient experienced hypopigmentation (1.22%), while 8 experienced acne flare-up (9.76%). Post-laser scars occurred in 2 patients (2.44%). Our data suggest that in atrophic acne scar treatment in Asians using fractional CO2 laser, 3 treatment sessions and duration of hyperpigmentation within 3 months have better outcomes regardless of energy, gender, age, Fitzpatrick skin type, follow-up duration, and disease course.

Modulation of skin microbiome in acne patients by aminolevulinic acid-photodynamic therapy.

BACKGROUND: Aminolevulinic acid-photodynamic therapy (ALA-PDT) has been an effective treatment for moderate to severe acne. However, the effect of ALA-PDT on skin microbiome in acne patients should also be examined.. AIM: To examine the composition, diversity, and resilience of skin microbiome in acne patients before and after ALA-PDT. METHOD: A prospective study was conducted on five patients with moderate to severe acne. All patients underwent a 5% ALA-PDT at a two-week interval for four sessions. Epidermal and follicular samples of acne patients were acquired for 16S rRNA gene amplicon metasequencing at baseline and before the final session. RESULT: ALA-PDT inhibited Cutibacterium acnes of follicular microbiome in acne. Follicular residential bacteria, mainly Bacillus and Lactococcus, rose in abundance after PDT. ALA-PDT increased the diversity of skin microbiome in acne and clustered follicular microbiome toward epidermal microbiome, both taxonomically and functionally. CONCLUSION: ALA-PDT exerts its therapeutic effect on acne partially through inhibiting C. acnes and modulating the composition and potential function of skin microbiome in acne.

Treatment of nevus of Ota with 1064 nm picosecond Nd:YAG laser: A retrospective study.

Nevus of Ota has been successfully treated by lasers. Currently, 1064 nm picosecond Nd:YAG lasers have become available for the treatment of pigmented disorders. However, there are few studies concerning the application of 1064 nm picosecond Nd:YAG laser in nevus of Ota. This study aimed to evaluate the efficacy and safety of a 1064 nm picosecond Nd:YAG laser for the treatment of nevus of Ota. We conducted a retrospective analysis of Chinese patients with nevus of Ota who had been treated with a 1064 nm picosecond Nd:YAG laser. Those who had any other laser treatment during the period of picosecond laser treatment were excluded. Via a visual analog scale for percentage of pigmentary clearance in standard photographs, the treatment efficacy was assessed by three blinded physician evaluators. A total of 16 subjects were included in this retrospective study. The average age at the beginning of treatment was 16.87 years old (range of 4 months to 59 years), and all patients were of Fitzpatrick skin type IV. Total treatment ranged from 1 to 5 sessions. A 1064 nm picosecond Nd:YAG laser with a mean fluence of 1.8-4.3 J/cm2 was used at 3-12 month intervals. The mean efficacy score for all 16 patients was 2.56 after one session, and the mean efficacy score of 13 patients who completed two sessions and nine patients who completed three sessions were 3.15 and 3.51, respectively. Postinflammatory hyperpigmentation after treatment was only observed in 1 (1/16, 6.25%) patient. The 1064 nm picosecond Nd:YAG laser is an effective and safe approach for treating nevus of Ota.

TRIM25 Rescues Against Doxorubicin-Induced Pyroptosis Through Promoting NLRP1 Ubiquitination.

Doxorubicin (DOX) is an antineoplastic agent that is widely employed in carcinomas, but it can cause cardiotoxicity in clinic. TRIM25 has E3 ubiquitin ligase activities and can ubiquitinate its target proteins. The role of TRIM25 in DOX-induced cardiotoxicity remains unknown. In this study, our results showed that DOX induced pyroptosis of H9c2 cells by TUNEL staining and Western blot assay. Interestingly, TRIM25 was downregulated in DOX-treated H9c2 cells in a time- and dose-dependent manner. TRIM25 attenuated DOX-induced pyroptosis of H9c2 cells. Furthermore, in vitro ubiquitination assay proved that TRIM25 decreased the stability of NLRP1 via promoting the ubiquitination of NLRP1. The rescue experiments confirmed that TRIM25 inhibited DOX-induced H9c2 cells pyroptosis by regulating NLRP1 stability. Animal experiments demonstrated that overexpression of TRIM25 attenuated DOX-induced cardiomyocyte pyroptosis in rats. In summary, TRIM25 exerts its cardioprotective effects by promoting the ubiquitination of NLRP1 in DOX-induced cardiomyocyte pyroptosis, which provides a novel therapeutic strategy for DOX-induced cardiotoxicity.

Construction and Evaluation of a Deep Learning Model for Assessing Acne Vulgaris Using Clinical Images.

INTRODUCTION: Accurate assessment is the basis for the effective treatment of acne vulgaris. The goal of this study was to achieve standardised diagnosis and treatment based on a deep learning model that was developed according to the current Chinese Guidelines for the Management of Acne Vulgaris. METHODS: The first step was to divide each image of acne vulgaris into four regions. Each of these four regions of the same patient was then combined to form a complete facial region. The second step was to classify the images based lesion type, in accordance with the current Chinese guidelines, and by treatment strategy adopted by experienced dermatologists. The final step was to evaluate the performance of the deep learning model in patients with acne vulgaris. RESULTS: The results showed that the average F1 value of the assessment model is 0.8 (optimum value = 1). The weighted kappa coefficient between the evaluation according to the artificial intelligence model and the evaluation by the attending dermatologists was 0.791 (95% confidence interval 0.671-0.910, P < 0.001), indicating a high degree of consistency. CONCLUSIONS: The assessment model based on deep learning and according to the Chinese guidelines had a slightly higher overall performance is comparable to that of the attending dermatologist.

The effects of ALA-PDT on microbiota in pilosebaceous units of patients with severe acne: A metagenomic study.

BACKGROUND: 5-aminolevulinic acid mediated photodynamic therapy (ALA-PDT) is increasingly used to control severe acne. However, its impact on skin microbiota remains uncertain. OBJECTIVES: We aimed to compare the makeup, diversity, and function of the microbiota in pilosebaceous units of patients with severe acne before and after ALA-PDT. METHODS: A longitudinal cohort study was performed on 11 participants with severe facial acne. All patients were given 5%ALA-PDT every two weeks for three sessions in total. The contents of lesions were sampled for metagenomic sequencing at baseline and two weeks after the first ALA-PDT session. RESULTS: Cutibacterium acnes was the most dominant species followed by Staphylococcus epidermidis and Pseudomonas fluorescens. Treatment with ALA-PDT led to clinical improvements in acne severity concurrent with a significant reduction in the relative abundance of C. acnes, while P. fluorescens increased significantly after ALA-PDT. No significant change was identified in other species. ALA-PDT administration was associated with an increased microbiota diversity and reductions in the relative abundance of the functional genes involved in energy metabolism and DNA replication. CONCLUSIONS: ALA-PDT plays a therapeutic role by killing C. acnes, increasing P. fluorescens and the microbiome diversity, while inhibiting the function of microbiota in pilosebaceous units of severe acne.

[Application of Artificial Intelligence in Clinical Genomics].

Clinical genomics mainly studies the clinical application of genomics in diagnosis,treatment decision,and prognosis prediction.Artificial intelligence enables the processing of complex and massive data in genomics which are difficult to be dealt with traditional algorithms and techniques.At present,artificial intelligence is involved in many tasks of clinical genomics,such as variant calling and classification,imaging and genetic diagnosis,electronic health record-based genetic diagnosis,and prediction of drug effect and adverse reaction.This review elaborates the application of artificial intelligence in different aspects of clinical genomics.

Development and validation of two artificial intelligence models for diagnosing benign, pigmented facial skin lesions.

OBJECTIVE: This study used deep learning for diagnosing common, benign hyperpigmentation. METHOD: In this study, two convolutional neural networks were used to identify six pigmentary diseases, and a disease diagnosis model was established. Because the distribution of lesions in the original training picture is very complex, we cropped the image around the lesions, trained the network on the extracted lesion images, and fused the verification results of the overall picture and the extracted picture to assess the model performance in identifying hyperpigmented dermatitis pictures. Finally, we evaluated the image recognition performance of the two convolutional neural networks and the converged networks in the test set through a comparison of the converged network and the physicians' assessments. RESULTS: The AUC of DenseNet-96 for the overall picture was 0.98, whereas the AUC of ResNet-152 was 0.96; therefore, we concluded that DenseNet-96 performed better than ResNet-152. From the AUC, the converged network has the best performance. The converged network model achieved a comprehensive classification performance comparable to that of the doctors. CONCLUSIONS: The diagnostic model for benign, pigmented skin lesions based on convolutional neural networks had a slightly higher overall performance than the skin specialists.

Hematoporphyrin monomethyl ether photodynamic therapy for the treatment of facial port-wine stains resistant to pulsed dye laser.

BACKGROUND: Pulsed dye laser is the first treatment choice for port-wine stains. However, as some facial port-wine stains are resistant to this modality, we evaluated the efficacy and safety of hematoporphyrin monomethyl ether (hemoporfin) photodynamic therapy for the treatment of such resistant port-wine stains. METHODS: Patients were treated with two sessions of hemoporfin photodynamic therapy in our department. Patients received an intravenous injection of hematoporphyrin monomethyl ether (5 mg/kg) followed by 532 nm LED green light therapy. Three physicians graded the improvement in the port-wine stain, using a 4-level scale. Patients' satisfaction, reaction to treatment, and adverse effects were evaluated. RESULTS: Thirty-one patients (mean age, 23.9 ± 11.9 years, range, 3-48 years) were enrolled in this study. Hypertrophic lesions accounted for 48.4% of port-wine stain, with 80.6% of lesions being larger than 40 cm2. With regard to location, 41.9% were located on the central face and 32.3% involved a mix of the central and peripheral face. After one session, a treatment response was identified in 87.1% of cases, with the response deemed 'significant' in 29.0%. After two sessions, these rates increased to 100.0% and 61.3%, respectively. The clinical effect after two sessions was significantly greater than that after one session. Treatment reactions and adverse effects were well tolerated, and included pruritus, burning sensation, pain, edema, purpura-like change, blister, crust, and hyperpigmentation. CONCLUSIONS: Hemoporfin photodynamic therapy is a promising treatment for port-wine stains resistant to pulsed dye laser therapy.