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, 刘华绪. 鲜红斑痣发病及治疗相关机制研究进展. 中国麻风皮肤病杂志, 2019, 35(9): 564-567.
6.	刘莲, 张自晖, 郝丹, 等. 鲜红斑痣的发病机制研究进展. 中国麻风皮肤病杂志, 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.	中华医学会整形外科分会血管瘤和脉管畸形学组. 血管瘤和脉管畸形的诊断及治疗指南(2019版). 组织工程与重建外科杂志, 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.	苑凯华. 鲜红斑痣畸形血管结构的光学检测及与疗效关系的研究. 广州: 南方医科大学, 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.	刘盛秀. 盐酸氨基酮戊酸光动力疗法治疗鲜红斑痣应用研究. 合肥: 安徽医科大学, 2012.
16.	吴秋菊, 周展超, 林彤, 等. 光动力疗法与脉冲染料激光治疗鲜红斑痣的临床比较. 中华皮肤科杂志, 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.	周扬, 黄乃艳, 顾瑛. 光动力疗法治疗鲜红斑痣的研究进展. 中国激光医学杂志, 2011, 20(1): 54-57.
22.	顾瑛, 李峻亨, 江亿平, 等. 光动力疗法选择性治疗鲜红斑痣的机制探讨. 中国激光医学杂志, 1992(3): 141-144, 177.
23.	陈圆芳, 张钰, 张佩莲. 脉冲染料激光在皮肤病治疗中的研究进展. 皮肤病与性病, 2019, 41(1): 20-23.
24.	Waner M. Classification of port-wine stains. Facial Plast Surg, 1989, 6(3): 162-166.
25.	顾瑛, 李峻亨, 江亿平, 等. 光动力学疗法选择性治疗鲜红斑痣的临床研究附40例报告. 中国激光医学杂志, 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.	苑凯华, 李勤, 张超, 等. 脉冲染料激光与光动力疗法治疗鲜红斑痣临床对比分析. 临床皮肤科杂志, 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.	张桃花. 光动力疗法与脉冲染料激光治疗儿童面部鲜红斑痣的疗效比较. 广州: 南方医科大学, 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.	梁富强, 沈毅, 顾瑛, 等. 光动力治疗光源的研究新进展. 激光生物学报, 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, 刘华绪. 鲜红斑痣发病及治疗相关机制研究进展. 中国麻风皮肤病杂志, 2019, 35(9): 564-567.
6. 刘莲, 张自晖, 郝丹, 等. 鲜红斑痣的发病机制研究进展. 中国麻风皮肤病杂志, 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. 中华医学会整形外科分会血管瘤和脉管畸形学组. 血管瘤和脉管畸形的诊断及治疗指南(2019版). 组织工程与重建外科杂志, 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. 苑凯华. 鲜红斑痣畸形血管结构的光学检测及与疗效关系的研究. 广州: 南方医科大学, 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. 刘盛秀. 盐酸氨基酮戊酸光动力疗法治疗鲜红斑痣应用研究. 合肥: 安徽医科大学, 2012.
16. 吴秋菊, 周展超, 林彤, 等. 光动力疗法与脉冲染料激光治疗鲜红斑痣的临床比较. 中华皮肤科杂志, 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. 周扬, 黄乃艳, 顾瑛. 光动力疗法治疗鲜红斑痣的研究进展. 中国激光医学杂志, 2011, 20(1): 54-57.
22. 顾瑛, 李峻亨, 江亿平, 等. 光动力疗法选择性治疗鲜红斑痣的机制探讨. 中国激光医学杂志, 1992(3): 141-144, 177.
23. 陈圆芳, 张钰, 张佩莲. 脉冲染料激光在皮肤病治疗中的研究进展. 皮肤病与性病, 2019, 41(1): 20-23.
24. Waner M. Classification of port-wine stains. Facial Plast Surg, 1989, 6(3): 162-166.
25. 顾瑛, 李峻亨, 江亿平, 等. 光动力学疗法选择性治疗鲜红斑痣的临床研究附40例报告. 中国激光医学杂志, 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. 苑凯华, 李勤, 张超, 等. 脉冲染料激光与光动力疗法治疗鲜红斑痣临床对比分析. 临床皮肤科杂志, 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. 张桃花. 光动力疗法与脉冲染料激光治疗儿童面部鲜红斑痣的疗效比较. 广州: 南方医科大学, 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. 梁富强, 沈毅, 顾瑛, 等. 光动力治疗光源的研究新进展. 激光生物学报, 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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