Pulsed Dye Laser Versus Photodynamic Therapy for the Treatment of Port Wine Stain: A Systematic Review and Meta-analysis

Objective: Vascular lesions, such as port wine stain (PWS), lead to facial and psychological problems that require careful and timely treatments. This review aims to compare 2 mainstream methods pulsed dye laser (PDL) therapy and photodynamic therapy (PDT) for PWS. Methods: The Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI) Full-Text Chinese Database, and VIP Chinese Scientific Journals Database were searched for literature comparing PDL versus PDT in treating PWS with no dates set. Studies were eligible for inclusion if they were randomized, placebo-controlled or head-to-head trials published in either English or Chinese. The primary outcome was overall response rate judged by the physician/investigator-reported outcome scoring system. Adverse effects were also recorded. Review Manager was used to perform data synthesis. Cochrane risk-of-bias tool was used for methodological quality assessment. Retrospective studies were assessed based on the Newcastle-Ottawa Scale. The review protocol was registered in the International Prospective Register of Systematic Reviews (CRD42021243960). Results: Twelve studies met the inclusion criteria, among which 8 studies had the data necessary for the meta-analysis. Among the 8 studies, 4 were retrospective studies with 1,075 patients. The other 4 were RCT studies with 532 randomized participants. Regarding the overall response rate of RCT studies, PDT demonstrated no significantly higher efficacy than PDL with risk ratio (RR) 0.76 (95% confidence interval [CI] 0.48–1.20). Regarding purple types, the overall response rate of PDT was statistically significantly superior to that of PDL with RR of 0.47 (95% CI: 0.29–0.79). In terms of red types, PDT also manifested no significantly higher efficacy compared with PDL with RR of 0.85 (95% CI: 0.27–2.71). Conclusion: PDT is an effective and safe treatment for different types of PWS and was more effective than PDL in treating purple type of PWS.