Pulsed dye laser alongside sirolimus and imiquimod cream may effectively treat port-wine stains

Port-wine stains (PWS) pose a treatment challenge, often requiring multiple sessions of pulsed dye laser (PDL) therapy for partial results. To enhance efficacy, researchers are investigating the synergy of adjuvant antiangiogenic topical therapies with PDL, aiming to revolutionise PWS treatment.

Recent research published in Lasers In Surgery And Medicine by Margaret Chou and colleagues conducted a comprehensive analysis of six randomised controlled trials involving 103 PWS patients. These trials explored the potential of adjuvant topical therapies alongside PDL, shedding light on innovative treatment possibilities.

• The studies examined three distinct adjuvant therapies: sirolimus, timolol, and imiquimod.

• Sirolimus, an antiangiogenic agent, yielded diverse outcomes. While two trials reported limited improvement in colorimetric analysis, one study showcased significant enhancement through Investigator Global Assessment (IGA) score and digital photographic image scoring (DPIA).

• Findings for timolol, a beta-blocker, indicated minimal change in PWS appearance compared to placebo.

• Incorporating 5% adjuvant imiquimod cream demonstrated remarkable progress in PWS treatment.

The review pinpointed challenges, including therapy concentration variations, differing durations, and inconsistent outcome measures. Despite these hurdles, the promising clinical potential of adjuvant topical therapies warrants further exploration. Larger prospective studies hold the key to unravelling the true effectiveness of these innovative strategies.

While current evidence leaves the effectiveness of adjuvant topical therapies in conjunction with PDL inconclusive, their exploration represents a leap forward in PWS treatment. As researchers dive deeper into these novel approaches, future investigations promise to refine and redefine the path to effective PWS management.

"There is no clarity on the efficacy of adjuvant topical therapy," the researchers wrote. Limitations included differences in follow-up time, variation in concentration and duration of adjuvant therapies, and inconsistent outcome measure reporting. 

"Given their potential clinical promise, larger prospective studies investigating topical adjuvant therapies should be considered," they concluded. 

Reference:

Chou, M., Karim, M., Josephs, J., Itzkowitz, T., Dreker, M. R., & Labadie, J. G. (2023). Pulsed dye laser and adjuvant topical therapies for the treatment of port‐wine stains: A systematic review. Lasers in Surgery and Medicine. https://doi.org/10.1002/lsm.23706