Supplementary Material for: Patient-reported outcomes of medical tattooing for capillary malformations

Background Patients with capillary malformations (CMs) may undergo medical tattooing (MT) as an alternative to laser therapy. But, little is known about treatment results and impact from the patients’ perspective. Objectives In this cross-sectional digital survey study, we evaluated the patient-reported outcomes of MT for CMs. Methods MT practices were identified via the Dutch Association of Skin Therapists and Google. These practices invited all their CM-patients who had undergone MT between January 2011–September 2021 to participate. Baseline and treatment characteristics, tattooing effectiveness, patient satisfaction with treatment outcomes, and complications were evaluated using a custom-made online survey. Quality of life (QoL) was assessed with the Dermatology Life Quality Index (DLQI) questionnaire. Factors associated with treatment effectiveness and patient satisfaction were identified via bivariate analysis and ordinal logistic regression analysis. Results Most of the 89 respondents were female (69%). Almost all CMs were located on the face (90%) and mainly (dark)red (74%). Nearly all patients had undergone laser therapy (91%). Median number of tattooing sessions was 5 (IQR: 4.0-8.0). Thirty-seven percent of the patients perceived >75% color reduction. Younger patients were more likely to obtain lower treatment effectiveness (OR 0.44, 95%CI: 0.20–0.97). Most patients (83%) were satisfied with treatment results. Patients with lighter- (OR 0.30, 95%CI: 0.13–0.72), non-facial- (OR 0.15, 95%CI: 0.03–0.89) and hypertrophic CMs (OR 0.30, 95%CI: 0.11–0.82) were less likely to be satisfied with treatment outcomes. Patients with lighter skin types were more satisfied (OR 2.89, 95%CI: 1.23–6.80). Complications included transient pain (23%), bleeding (3.4%), hypertrophic scarring (1.1%), hypopigmentation (1.1%), and a halo around the tattoo (1.1%). Conclusion MT seems a valid alternative treatment in addition to laser therapy for CMs, with mild complications. Most patients are (very)satisfied with treatment results, while color reduction is incomplete. Hence, it seems appropriate to decide together with patients whether or not to use MT as primary treatment or secondary to laser therapy.

背景 毛细血管畸形（capillary malformations, CMs）患者可选择医疗文饰（medical tattooing, MT）作为激光治疗的替代方案，但目前从患者视角出发的治疗效果与影响相关研究尚少。
目的 本项横断面数字化调查研究旨在评估毛细血管畸形患者接受医疗文饰治疗后的患者报告结局。
方法 本研究通过荷兰皮肤治疗师协会与谷歌检索确定医疗文饰机构，邀请其所有在2011年1月至2021年9月期间接受过医疗文饰的毛细血管畸形患者参与研究。采用自制在线问卷评估患者的基线与治疗特征、文饰效果、治疗结局满意度及并发症情况；使用皮肤病生活质量指数（Dermatology Life Quality Index, DLQI）量表评估患者的生活质量（quality of life, QoL）。通过双变量分析与有序logistic回归分析，识别与治疗效果及患者满意度相关的影响因素。
结果 89名受访者中大多数为女性（69%）。几乎所有患者的病变部位均位于面部（90%），病变颜色以（深）红色为主（74%）。近九成患者（91%）此前接受过激光治疗。患者接受文饰治疗的中位次数为5次（四分位数间距：4.0~8.0）。37%的患者认为病变颜色减退幅度超过75%。年龄较小的患者治疗效果更差（比值比OR=0.44，95%置信区间CI：0.20~0.97）。多数患者（83%）对治疗效果表示满意。病变颜色较浅（OR=0.30，95%CI：0.13~0.72）、非面部部位病变（OR=0.15，95%CI：0.03~0.89）及肥厚型毛细血管畸形患者（OR=0.30，95%CI：0.11~0.82）对治疗结局的满意度更低。皮肤分型较浅的患者满意度更高（OR=2.89，95%CI：1.23~6.80）。并发症包括一过性疼痛（23%）、出血（3.4%）、肥厚性瘢痕（1.1%）、色素减退（1.1%）及文饰周围晕圈（1.1%）。
结论 对于毛细血管畸形患者而言，医疗文饰作为激光治疗之外的替代方案具备可行性，且并发症轻微。多数患者对治疗效果（非常）满意，但病变颜色减退并不完全。因此，临床中可与患者共同商议，将医疗文饰作为一线治疗或激光治疗后的二线治疗方案。