Photodynamic therapy of port-wine stains: long-term efficacy and complication in Chinese patients

Port-wine stain (PWS) are congenital vascular malformations characterized by ectatic capillaries in the papillary layer of the dermis. They usually appear at birth and tend to become darker and thicker with age. Many clinicians consider the gold standard to treat PWS is pulsed dye laser (PDL) with wavelengths of 585 nm or 595 nm. But PDL is not suitable for patients with Fitzpatrick skin type V or nodular lesions. Vascular-targeted photodynamic therapy (PDT) might be an alternative approach in the treatment of such patients. The objective of this study was to assess the long-term outcomes and complications of PDT therapy of PWS in Chinese patients retrospectively. Patients with PWS who had received PDT therapy in a 5-year period were reviewed. 642 patients and a total of 3066 treatment sessions had been performed with an average of 2.6-8.2 sessions. Over 5% of patients had complete clearing, while 70% of patients had more than 25% of clearing. More than one-quarter of patients (29.8%) experienced a clearing of more than 50%. Ten percent of patients experienced complications (1.4% blistering, 1.2% hypopigmentation, 4.3% hyperpigmentation, 2.2% scabbing, <0.7% prolonged blistering that persisted for >2 months, 0.4% eczema dermatitis, 0.6% photoallergy). Sex, age, number of treatment sessions, average energy density and type of skin were not related to complication rate using the multiple regression analysis. Chinese patients were well responsive to and satisfied with vascular-targeted PDT (Patient Satisfaction Score 7.8). Dark-skinned patients and patients with vascular papules or nodules can be treated with alternative PDT to significant therapeutic effect in Chinese patients even though they experience few complications.