A meta-analysis of the efficacy and safety for port wine stains by photodynamic therapy_West China Medical Journal

Authors：

TIAN Run ,  WEN Xiang

Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

WEN Xiang, Email: Xiangwen_wcums@163.com

Keywords：

Port wine stains; Photodynamic therapy; Pulsed dye laser; Meta-analysis

DOI：

10.7507/1002-0179.201911229

Video：

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Objective To evaluate the efficacy and safety of photodynamic treatment for port wine stains compared with gold standard pulsed dye laser.Methods A literature search was performed in PubMed, CENTRAL, Embase, Web of Science, China National Knowledge Infrastructure, CQVIP, and Wanfang to identify the clinical randomized controlled studies on photodynamic therapy, pulsed dye laser, and port wine stains, which were published from the establishment of the databases to April 3rd, 2021, and the outcome measurements included effective rate and incidence of adverse reactions. Data were extracted and meta-analysis was performed with RevMan5.3 software, and the quality of evidence was evaluated according to GRADE standards.Results Three randomized controlled studies were included, with a total of 268 cases of port wine stains. Meta-analysis results showed that there was no statistically significant difference in the efficacy [relative risk (RR) =1.08, 95% confidence interval (CI) (0.89, 1.32), P=0.42] or the incidence of pigmentation [RR=1.03, 95%CI (0.65, 1.65), P=0.89] between photodynamic therapy and pulsed dye laser in the treatment of port wine stains.Conclusions The effectiveness and the occurrence of pigmentation of photodynamic therapy on port wine stains are not significantly different from those of pulsed dye laser. Photodynamic therapy is an effective and safe method for the treatment of port wine stains. Due to the limited literature included, large-scale prospective clinical trials are still needed to verify the conclusion.

Citation： TIAN Run, WEN Xiang. A meta-analysis of the efficacy and safety for port wine stains by photodynamic therapy. West China Medical Journal, 2021, 36(4): 499-505. doi: 10.7507/1002-0179.201911229 Copy

1.	Schneider BV, Mitsuhashi Y, Schnyder UW. Ultrastructural observations in port wine stains. Arch Dermatol Res, 1988, 280(6): 338-345.
2.	Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics, 1976, 58(2): 218-222.
3.	Chen JK, Ghasri P, Aguilar G, et al. An overview of clinical and experimental treatment modalities for port wine stains. J Am Acad Dermatol, 2012, 67(2): 289-304.
4.	Minkis K, Geronemus RG, Hale EK. Port wine stain progression: a potential consequence of delayed and inadequate treatment?. Lasers Surg Med, 2009, 41(6): 423-426.
5.	王美玲, 劉華緒. 鮮紅斑痣發病及治療相關機制研究進展. 中國麻風皮膚病雜志, 2019, 35(9): 564-567.
6.	劉蓮, 張自暉, 郝丹, 等. 鮮紅斑痣的發病機制研究進展. 中國麻風皮膚病雜志, 2019(4): 253- 256.
7.	Updyke KM, Khachemoune A. Port-wine stains: a focused review on their management. J Drugs Dermatol, 2017, 16(11): 1145-1151.
8.	Michel S, Landthaler M, Hohenleutner U. Recurrence of port-wine stains after treatment with the flashlamp-pumped pulsed dye laser. Br J Dermatol, 2000, 143(6): 1230-1234.
9.	中華醫學會整形外科分會血管瘤和脈管畸形學組. 血管瘤和脈管畸形的診斷及治療指南(2019版). 組織工程與重建外科雜志, 2019, 15(5): 277-317.
10.	Aguayo-Albasini JL, Flores-Pastor B, Soria-Aledo V. GRADE system: classification of quality of evidence and strength of recommendation. Cir Esp, 2014, 92(2): 82-88.
11.	Evans AV, Robson A, Barlow RJ, et al. Treatment of port wine stains with photodynamic therapy, using pulsed dye laser as a light source, compared with pulsed dye laser alone: a pilot study. Lasers Surg Med, 2005, 36(4): 266-269.
12.	苑凱華. 鮮紅斑痣畸形血管結構的光學檢測及與療效關系的研究. 廣州: 南方醫科大學, 2012.
13.	Tournas JA, Lai J, Truitt A, et al. Combined benzoporphyrin derivative monoacid ring photodynamic therapy and pulsed dye laser for port wine stain birthmarks. Photodiagnosis Photodyn Ther, 2009, 6(3/4): 195-199.
14.	Gao K, Huang Z, Yuan KH, et al. Side-by-side comparison of photodynamic therapy and pulsed-dye laser treatment of port-wine stain birthmarks. Br J Dermatol, 2013, 168(5): 1040-1046.
15.	劉盛秀. 鹽酸氨基酮戊酸光動力療法治療鮮紅斑痣應用研究. 合肥: 安徽醫科大學, 2012.
16.	吳秋菊, 周展超, 林彤, 等. 光動力療法與脈沖染料激光治療鮮紅斑痣的臨床比較. 中華皮膚科雜志, 2016, 49(8): 587-590.
17.	Tang Y, Xie H, Li J, et al. The association between treatment reactions and treatment efficiency of hemoporfin-photodynamic therapy on port wine stains: a prospective double blind randomized controlled trial. Photodiagnosis Photodyn Ther, 2017, 18: 171-178.
18.	Yuan KH, Li Q, Yu WL, et al. Comparison of photodynamic therapy and pulsed dye laser in patients with port wine stain birthmarks: a retrospective analysis. Photodiagnosis Photodyn Ther, 2008, 5(1): 50-57.
19.	van Raath MI, Chohan S, Wolkerstorfer A, et al. Port wine stain treatment outcomes have not improved over the past three decades. J Eur Acad Dermatol Venereol, 2019, 33(7): 1369-1377.
20.	Aguilar G, Choi B, Broekgaarden M, et al. An overview of three promising mechanical, optical, and biochemical engineering approaches to improve selective photothermolysis of refractory port wine stains. Ann Biomed Eng, 2012, 40(2): 486-506.
21.	周揚, 黃乃艷, 顧瑛. 光動力療法治療鮮紅斑痣的研究進展. 中國激光醫學雜志, 2011, 20(1): 54-57.
22.	顧瑛, 李峻亨, 江億平, 等. 光動力療法選擇性治療鮮紅斑痣的機制探討. 中國激光醫學雜志, 1992(3): 141-144, 177.
23.	陳圓芳, 張鈺, 張佩蓮. 脈沖染料激光在皮膚病治療中的研究進展. 皮膚病與性病, 2019, 41(1): 20-23.
24.	Waner M. Classification of port-wine stains. Facial Plast Surg, 1989, 6(3): 162-166.
25.	顧瑛, 李峻亨, 江億平, 等. 光動力學療法選擇性治療鮮紅斑痣的臨床研究附40例報告. 中國激光醫學雜志, 1992, 1(1): 6-10.
26.	Zhang B, Zhang TH, Huang Z, et al. Comparison of pulsed dye laser (PDL) and photodynamic therapy (PDT) for treatment of facial port-wine stain (PWS) birthmarks in pediatric patients. Photodiagnosis Photodyn Ther, 2014, 11(4): 491-497.
27.	苑凱華, 李勤, 張超, 等. 脈沖染料激光與光動力療法治療鮮紅斑痣臨床對比分析. 臨床皮膚科雜志, 2009, 38(2): 126-128.
28.	Qiu H, Gu Y, Wang Y, et al. Twenty years of clinical experience with a new modality of vascular-targeted photodynamic therapy for port wine stains. Dermatol Surg, 2011, 37(11): 1603-1610.
29.	Kautz G, Kautz I, Segal J, et al. Treatment of resistant port wine stains (PWS) with pulsed dye laser and non-contact vacuum: a pilot study. Lasers Med Sci, 2010, 25(4): 525-529.
30.	Zhao Y, Tu P, Zhou G, et al. Hemoporfin photodynamic therapy for port-wine stain: a randomized controlled trial. PLoS One, 2016, 11(5): e0156219.
31.	張桃花. 光動力療法與脈沖染料激光治療兒童面部鮮紅斑痣的療效比較. 廣州: 南方醫科大學, 2014.
32.	Yuan KH, Li Q, Yu WL, et al. Photodynamic therapy in treatment of port wine stain birthmarks--recent progress. Photodiagnosis Photodyn Ther, 2009, 6(3/4): 189-194.
33.	梁富強, 沈毅, 顧瑛, 等. 光動力治療光源的研究新進展. 激光生物學報, 2019, 28(2): 97-108.
34.	Wu Q, Tu P, Zhou G, et al. A dose-finding study for hemoporfin in photodynamic therapy for port-wine stain: a multicenter randomized double-blind phase IIb trial. Photodermatol Photoimmunol Photomed, 2018, 34(5): 314-321.

1. Schneider BV, Mitsuhashi Y, Schnyder UW. Ultrastructural observations in port wine stains. Arch Dermatol Res, 1988, 280(6): 338-345.
2. Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics, 1976, 58(2): 218-222.
3. Chen JK, Ghasri P, Aguilar G, et al. An overview of clinical and experimental treatment modalities for port wine stains. J Am Acad Dermatol, 2012, 67(2): 289-304.
4. Minkis K, Geronemus RG, Hale EK. Port wine stain progression: a potential consequence of delayed and inadequate treatment?. Lasers Surg Med, 2009, 41(6): 423-426.
5. 王美玲, 劉華緒. 鮮紅斑痣發病及治療相關機制研究進展. 中國麻風皮膚病雜志, 2019, 35(9): 564-567.
6. 劉蓮, 張自暉, 郝丹, 等. 鮮紅斑痣的發病機制研究進展. 中國麻風皮膚病雜志, 2019(4): 253- 256.
7. Updyke KM, Khachemoune A. Port-wine stains: a focused review on their management. J Drugs Dermatol, 2017, 16(11): 1145-1151.
8. Michel S, Landthaler M, Hohenleutner U. Recurrence of port-wine stains after treatment with the flashlamp-pumped pulsed dye laser. Br J Dermatol, 2000, 143(6): 1230-1234.
9. 中華醫學會整形外科分會血管瘤和脈管畸形學組. 血管瘤和脈管畸形的診斷及治療指南(2019版). 組織工程與重建外科雜志, 2019, 15(5): 277-317.
10. Aguayo-Albasini JL, Flores-Pastor B, Soria-Aledo V. GRADE system: classification of quality of evidence and strength of recommendation. Cir Esp, 2014, 92(2): 82-88.
11. Evans AV, Robson A, Barlow RJ, et al. Treatment of port wine stains with photodynamic therapy, using pulsed dye laser as a light source, compared with pulsed dye laser alone: a pilot study. Lasers Surg Med, 2005, 36(4): 266-269.
12. 苑凱華. 鮮紅斑痣畸形血管結構的光學檢測及與療效關系的研究. 廣州: 南方醫科大學, 2012.
13. Tournas JA, Lai J, Truitt A, et al. Combined benzoporphyrin derivative monoacid ring photodynamic therapy and pulsed dye laser for port wine stain birthmarks. Photodiagnosis Photodyn Ther, 2009, 6(3/4): 195-199.
14. Gao K, Huang Z, Yuan KH, et al. Side-by-side comparison of photodynamic therapy and pulsed-dye laser treatment of port-wine stain birthmarks. Br J Dermatol, 2013, 168(5): 1040-1046.
15. 劉盛秀. 鹽酸氨基酮戊酸光動力療法治療鮮紅斑痣應用研究. 合肥: 安徽醫科大學, 2012.
16. 吳秋菊, 周展超, 林彤, 等. 光動力療法與脈沖染料激光治療鮮紅斑痣的臨床比較. 中華皮膚科雜志, 2016, 49(8): 587-590.
17. Tang Y, Xie H, Li J, et al. The association between treatment reactions and treatment efficiency of hemoporfin-photodynamic therapy on port wine stains: a prospective double blind randomized controlled trial. Photodiagnosis Photodyn Ther, 2017, 18: 171-178.
18. Yuan KH, Li Q, Yu WL, et al. Comparison of photodynamic therapy and pulsed dye laser in patients with port wine stain birthmarks: a retrospective analysis. Photodiagnosis Photodyn Ther, 2008, 5(1): 50-57.
19. van Raath MI, Chohan S, Wolkerstorfer A, et al. Port wine stain treatment outcomes have not improved over the past three decades. J Eur Acad Dermatol Venereol, 2019, 33(7): 1369-1377.
20. Aguilar G, Choi B, Broekgaarden M, et al. An overview of three promising mechanical, optical, and biochemical engineering approaches to improve selective photothermolysis of refractory port wine stains. Ann Biomed Eng, 2012, 40(2): 486-506.
21. 周揚, 黃乃艷, 顧瑛. 光動力療法治療鮮紅斑痣的研究進展. 中國激光醫學雜志, 2011, 20(1): 54-57.
22. 顧瑛, 李峻亨, 江億平, 等. 光動力療法選擇性治療鮮紅斑痣的機制探討. 中國激光醫學雜志, 1992(3): 141-144, 177.
23. 陳圓芳, 張鈺, 張佩蓮. 脈沖染料激光在皮膚病治療中的研究進展. 皮膚病與性病, 2019, 41(1): 20-23.
24. Waner M. Classification of port-wine stains. Facial Plast Surg, 1989, 6(3): 162-166.
25. 顧瑛, 李峻亨, 江億平, 等. 光動力學療法選擇性治療鮮紅斑痣的臨床研究附40例報告. 中國激光醫學雜志, 1992, 1(1): 6-10.
26. Zhang B, Zhang TH, Huang Z, et al. Comparison of pulsed dye laser (PDL) and photodynamic therapy (PDT) for treatment of facial port-wine stain (PWS) birthmarks in pediatric patients. Photodiagnosis Photodyn Ther, 2014, 11(4): 491-497.
27. 苑凱華, 李勤, 張超, 等. 脈沖染料激光與光動力療法治療鮮紅斑痣臨床對比分析. 臨床皮膚科雜志, 2009, 38(2): 126-128.
28. Qiu H, Gu Y, Wang Y, et al. Twenty years of clinical experience with a new modality of vascular-targeted photodynamic therapy for port wine stains. Dermatol Surg, 2011, 37(11): 1603-1610.
29. Kautz G, Kautz I, Segal J, et al. Treatment of resistant port wine stains (PWS) with pulsed dye laser and non-contact vacuum: a pilot study. Lasers Med Sci, 2010, 25(4): 525-529.
30. Zhao Y, Tu P, Zhou G, et al. Hemoporfin photodynamic therapy for port-wine stain: a randomized controlled trial. PLoS One, 2016, 11(5): e0156219.
31. 張桃花. 光動力療法與脈沖染料激光治療兒童面部鮮紅斑痣的療效比較. 廣州: 南方醫科大學, 2014.
32. Yuan KH, Li Q, Yu WL, et al. Photodynamic therapy in treatment of port wine stain birthmarks--recent progress. Photodiagnosis Photodyn Ther, 2009, 6(3/4): 189-194.
33. 梁富強, 沈毅, 顧瑛, 等. 光動力治療光源的研究新進展. 激光生物學報, 2019, 28(2): 97-108.
34. Wu Q, Tu P, Zhou G, et al. A dose-finding study for hemoporfin in photodynamic therapy for port-wine stain: a multicenter randomized double-blind phase IIb trial. Photodermatol Photoimmunol Photomed, 2018, 34(5): 314-321.

West China Medical Journal

A meta-analysis of the efficacy and safety for port wine stains by photodynamic therapy

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