Combined benzoporphyrin derivative monoacid ring photodynamic therapy and pulsed dye laser for port wine stain birthmarks

Background: Pulsed dye laser (PDL) is a commonty utilized treatment for port wine stain birthmarks (PWS) in the United States; however, results are variable and few patients achieve complete removal. Photodynamic therapy (PDT) is commonly used in China, but treatment associated photosensitivity lasts several weeks and scarring may occur. We propose an alternative treatment option, combined PDT + PDL and performed a proof-of-concept preliminary clinical trial. Methods: Subjects with non-facial PWS were studied. Each subject had four test sites: control, PDL alone, PDT atone (benzoporphyrin derivative monoacid ring A photosensitizer with 576 nm light), and PDT + PDL. Radiant exposure time for PDT was increased in increments of 15 J/cm(2). Authors evaluated photographs and chromametric measurements before and 12 weeks post-treatment. Results: No serious adverse events were reported; epidermal changes were mild and self-limited. No clinical blanching was noted in control or PDT-alone sites. At PDT radiant exposures of 15 and 30 J/cm(2), equivalent purpura and blanching was observed at PDL and PDT + PDL sites. At PDT radiant exposures over 30 J/cm(2), greater purpura was noted at PDT + PDL sites as compared to PDL alone. Starting at 75 J/cm(2), improved blanching was noted at PDT + PDL sites. Conclusions: Preliminary results indicate that PDT + PDL is safe and may offer improved PWS treatment efficacy. Additional studies are warranted. (C) 2009 Elsevier B.V. All rights reserved.