Study of Treatment and Patient Factors of Hemoporfin-Photodynamic Therapy for Port-Wine Stains

Abstract

Background. Port-wine stains (PWS) affect a substantial number of people, and despite the use of pulsed dye laser as the gold standard therapy, some patients fail to respond, and new modalities are needed. Recently, hemoporfin-photodynamic therapy (hemoporfin-PDT) has shown good efficacy and safety in treating PWS, with increasing evidence. Objectives. To evaluate the efficacy and safety of hemoporfin-PDT in the treatment of PWS and to analyze the factors that influence efficacy. Methods. The clinical data of 215 patients (79 men and 136 women aged 3–71 years) from a single center were retrospectively analyzed, out of which 173 were valid for efficacy analysis and 129 for safety analysis. Efficacy was rated as excellent (≥75% improvement), good (≥50% to <75% improvement), fair (≥25% to <50%), and poor (<25% improvement) by two blinded dermatologists. The patient-assessed efficacy was collected based on the aforementioned criteria using an electronic questionnaire. The association of efficacy with possible influential factors was investigated, namely, age, sex, history of previous treatment, combined scars caused by previous treatments, lesion site, lesion type, lesion size, degree of lip involvement, and number of hemoporfin-PDT sessions. Adverse events were investigated to evaluate the safety profile. Results. Excellent, good, fair, and poor efficacy was achieved in 78 (45.1%), 38 (22.0%), 36 (20.8%), and 21 (12.1%) patients, respectively, after a variable number of sessions of hemoporfin-PDT. More treatment sessions (p < 0.001), age ≥18 years (p = 0.037), no previous treatments (p = 0.020), and head/neck location (p = 0.009) were associated with better outcomes. Pain, edema, exudation/crusting, and hyperpigmentation were common adverse events, with satisfactory recovery. Scarring occurred in 2.3% of the patients. Conclusions. For treating PWS with hemoporfin-PDT, more treatment sessions and head/neck location are predictors of better outcomes, whereas previous treatment history is a predictor of poorer outcomes.