Nguyen Lynhda, Sorbe Christina, Schoen Gerhard, Schneider Stefan W, Herberger Katharina
Department of Laser and Aesthetic, Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Dtsch Dermatol Ges. 2025 Mar;23(3):293-301. doi: 10.1111/ddg.15612. Epub 2024 Dec 12.
Port-wine birthmarks (PWB) are common vascular malformations in infants. Despite various laser and light-based treatments, comparative data on their effectiveness is limited. This study compares different treatments for PWB using a systematic review and network meta-analysis (NMA). We searched for randomized controlled trials (RCTs) and ongoing studies up to November 2023: Primary outcomes were patient satisfaction, investigator-assessed reduction in redness, and long-term adverse events (AEs). Risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. We identified 27 RCTs for qualitative analysis and twelve RCTs for the NMA, covering 1033 observations, 19 treatments, and three sub-networks. Seven studies reported on patient satisfaction. Hemoporfin-mediated photodynamic therapy was more effective in lesion clearance than PDL but had the highest risk of AEs. The 755 nm alexandrite laser and the combination of 595 nm PDL + 1064 nm Nd:YAG also showed high AE risks. Treatment discontinuation rates due to AEs did not significantly differ. Most studies had unclear bias risks, mostly owing to insufficient reporting. This study is the first NMA comparing laser- and light-based therapies for PWB. Further well-designed studies are warranted to determine optimal methods and patient-influencing factors for individualized treatments.
葡萄酒色斑（PWB）是婴儿常见的血管畸形。尽管有各种基于激光和光的治疗方法，但关于其有效性的比较数据有限。本研究使用系统评价和网络荟萃分析（NMA）比较了PWB的不同治疗方法。我们检索了截至2023年11月的随机对照试验（RCT）和正在进行的研究：主要结局是患者满意度、研究者评估的发红减轻情况以及长期不良事件（AE）。使用Cochrane偏倚风险2工具评估偏倚风险。我们确定了27项RCT进行定性分析，12项RCT进行NMA，涵盖1033次观察、19种治疗方法和三个子网络。七项研究报告了患者满意度。血卟啉介导的光动力疗法在病变清除方面比脉冲染料激光（PDL）更有效，但不良事件风险最高。755nm翠绿宝石激光以及595nm PDL + 1064nm Nd:YAG的联合治疗也显示出较高的不良事件风险。因不良事件导致的治疗中断率没有显著差异。大多数研究的偏倚风险不明确，主要是由于报告不足。本研究是第一项比较PWB激光和光基治疗的NMA。需要进一步设计良好的研究来确定个体化治疗的最佳方法和影响患者的因素。
