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及治疗影响相关研究仍较为匮乏。 研究目的：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（patient-reported outcomes, PROs）。 研究方法：本研究通过荷兰皮肤治疗师协会（Dutch Association of Skin Therapists）及谷歌（Google）检索相关医疗文饰执业机构，邀请其所有在2011年1月至2021年9月期间接受过医疗文饰治疗的毛细血管畸形患者参与调研。研究采用自制线上问卷，对患者的基线特征、治疗相关特征、文饰治疗效果、治疗满意度及并发症发生情况进行评估；采用皮肤病学生活质量指数（Dermatology Life Quality Index, DLQI）问卷评估患者的生活质量（quality of life, QoL）。通过双变量分析及有序逻辑回归分析，明确与治疗效果及患者满意度相关的影响因素。 研究结果：本次调研共回收89份有效问卷，其中多数受访者为女性（69%）。近九成（90%）患者的毛细血管畸形病变位于面部，且以（深）红色调病变为主（74%）。几乎所有患者（91%）此前均接受过激光治疗。患者接受的文饰治疗中位次数为5次（四分位距：4.0~8.0）。37%的患者反馈病变颜色消退幅度超过75%。年龄较小的患者获得较低治疗效果的概率更高（优势比（odds ratio, OR）=0.44，95%置信区间（confidence interval, 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）、病变位于非面部区域（OR=0.15，95%CI：0.03~0.89）以及存在肥厚性毛细血管畸形的患者（OR=0.30，95%CI：0.11~0.82）对治疗效果满意的概率更低；而肤色较浅的患者满意度更高（OR=2.89，95%CI：1.23~6.80）。本次调研记录的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%）及文饰区域周围晕圈（1.1%）。 研究结论：医疗文饰可作为毛细血管畸形激光治疗之外的有效替代方案，且并发症程度较轻。多数患者对治疗效果表示（非常）满意，但病变颜色消退并不完全。因此，临床中可与患者共同决策，将医疗文饰作为一线治疗方案或激光治疗后的辅助治疗手段。