The Efficacy of Hematoporphyrin Monomethyl Ether Photodynamic Therapy in Adult Patients with Port-Wine Stains: A Retrospective Study

Abstract

Introduction: Hematoporphyrin monomethyl ether-photodynamic therapy (HMME-PDT) has been showing promising results in the treatment of port-wine stains (PWSs). We evaluated the clinical efficacy and treatment response of HMME-PDT in adult Chinese patients with PWSs. Methods: A single-center retrospective study recruited adult PWS patients with negative HMME skin test results from December 2017 to May 2020. Patients received an intravenous injection of 5 mg/kg HMME and the lesions were exposed to 532 nm LED green light with an irradiation power density of 85-95 mW/cm 2 for 20-25 min. Digital photographs were taken before and after two therapy sessions and observed by three blinded dermatologists for clinical response. Results: A total of 72 patients aged between 18 and 55 years were recruited. There were 65 patients of the flat purple type, 5 of the hypertrophic type, and 2 of the nodular thickening type. Of the 65 patients, 7 showed excellent efficacy (10.77%), 13 patients indicated good efficacy (20.00%), 47 patients showed fair efficacy (64.62%), while 3 cases displayed no improvement (4.62%). All five patients of the purple and hypertrophic type showed fair efficacy (100%), and no improvement was observed in patients of the nodular thickening type (100%). Pain, pruritus, and a burning sensation were observed during treatment. Edema was noted on the treated areas post-treatment. No other obvious systemic adverse reactions were observed. Conclusion: HMME-PDT is an effective and safe treatment for adult patients with purple PWSs. Multiple HMME-PDT treatments can improve the response and cure rate.

The Relationship Between the Effectiveness of HMME-PDT and the Dermoscopic Features of Port-wine Stains in Chinese Pediatric Patients: A Retrospective Study

“…Between December 2017 and May 2020, pediatric patients with PWS who had normal renal and hepatic function and no prior treatment with laser, PDT, isotopes, topical or systemic treatment for PWS in the previous 4 weeks were enrolled in this study [ 20 ]. Written informed consent was obtained from the patients’ parents or legal guardians before treatment.…”

“…All patients received HMME-PDT as previously described [ 20 ]. Briefly, the dosage of photosensitizer was calculated (5 mg/kg), and the surrounding normal skin was covered with two layers of black fabric.…”

“…After two treatment sessions, three blinded dermatologists independently reviewed the clinical and dermoscopic images before and after treatment. According to the degree of color blanching from baseline, efficacy was assessed as follows: excellent efficacy: the color had almost or completely faded (≥ 90% improvement); good efficacy: the color had significantly faded (≥ 60% to < 90% improvement); fair: the color had partially faded (≥ 20% to < 60% improvement); no improvement: the color was mostly unchanged (< 20% improvement) [ 20 , 21 ].…”

Pathogenesis of Port-Wine Stains: Directions for Future Therapies

“…As PDT has developed rapidly in recent years, the effectiveness of PWS treatment has greatly increased. Copper vapor lasers and 532 nm LED green light are used to activate the photosensitizers, but the penetration depth of the laser and LED is limited [ 105 , 106 ]. A study revealed that PDT destroyed the vessels within 800 μm of the dermal–epidermal junction [ 107 ].…”

“…Moreover, the mean vessel depths of red, purple, and hypertrophic PWSs were 396.4 ± 31 μm, 944.2 ± 105.4 μm, and 2971 ± 161.3 μm, respectively. Hence, the treatment of hypertrophic PWSs remains difficult, and new PDT with next-generation photosensitizers is needed [ 105 ]. PDT requires three elements: light, photosensitizers, and molecular oxygen.…”