Summary Background/Purpose Previous studies have shown that hemoporfin‐mediated photodynamic therapy ( PDT ) was a treatment for port‐wine stain ( PWS ). Our current study aimed to identify optimal hemoporfin dose. Methods A prospective, multicenter, double‐blind, randomized clinical trial was conducted. Patients were assigned into low‐ or high‐dose hemoporfin (2.5 mg/kg and 5 mg/kg intravenously, respectively), or control (placebo) group, at a rate of 2:2:1. Treatment efficacy was evaluated at week 8. Then, patients in control group were randomly assigned into either high‐ or low‐dose hemoporfin group. Treatment reactions and adverse events were analyzed at week 16. Results A total of 100 patients (40, 40, 20 in low‐, high‐dose hemoporfin, and control group, respectively) were enrolled. Compared to low dose (40%) and control group (15%), a higher proportion of patients in high‐dose group (75%) had achieved skin lesion improvements. Treatment satisfactions were graded highest in high‐dose group. Compared to low‐dose group (14.3%), high‐dose group (46.0%) had more frequent skin hyperpigmentation, which disappeared 3‐6 months after treatment. Other treatment reactions and adverse events were comparable between two groups. Conclusions Photodynamic therapy with 5 mg/kg hemoporfin could be an effective and safe treatment for PWS .