Hematoporphyrin monomethyl ether photodynamic therapy for the treatment of facial port-wine stains resistant to pulsed dye laser

•Assessment of efficacy of hemoporfin/photodynamic therapy for port-wine stains.•Of the 31 lesions, a positive response was obtained in 87.1% after one treatment.•The clinical effect was greater after two sessions.•Adverse effects were well-tolerated and resolved in all cases.•Hemoporfin/photodynamic therapy is effective for resistant port-wine stains. Pulsed dye laser is the first treatment choice for port-wine stains. However, as some facial port-wine stains are resistant to this modality, we evaluated the efficacy and safety of hematoporphyrin monomethyl ether (hemoporfin) photodynamic therapy for the treatment of such resistant port-wine stains. Patients were treated with two sessions of hemoporfin photodynamic therapy in our department. Patients received an intravenous injection of hematoporphyrin monomethyl ether (5 mg/kg) followed by 532 nm LED green light therapy. Three physicians graded the improvement in the port-wine stain, using a 4-level scale. Patients’ satisfaction, reaction to treatment, and adverse effects were evaluated. Thirty-one patients (mean age, 23.9 ± 11.9 years, range, 3−48 years) were enrolled in this study. Hypertrophic lesions accounted for 48.4% of port-wine stain, with 80.6% of lesions being larger than 40 cm2. With regard to location, 41.9% were located on the central face and 32.3% involved a mix of the central and peripheral face. After one session, a treatment response was identified in 87.1% of cases, with the response deemed ‘significant’ in 29.0%. After two sessions, these rates increased to 100.0% and 61.3%, respectively. The clinical effect after two sessions was significantly greater than that after one session. Treatment reactions and adverse effects were well tolerated, and included pruritus, burning sensation, pain, edema, purpura-like change, blister, crust, and hyperpigmentation. Hemoporfin photodynamic therapy is a promising treatment for port-wine stains resistant to pulsed dye laser therapy.