Laser and light-based treatments for port-wine birthmarks - a systematic review and network meta-analysis

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.