From the Guidelines
Port wine stains are permanent birthmarks characterized by reddish-purple discoloration of the skin, caused by an abnormal development of low-flow, thin-walled ectatic postcapillary venules. These birthmarks usually occur on the face, neck, arms, or legs and do not fade over time. While port wine stains are generally harmless, they can cause emotional distress due to their appearance. In some cases, they may be associated with other medical conditions, such as Sturge-Weber syndrome. The key characteristics of port wine stains are:
- Permanent birthmarks with reddish-purple discoloration
- Caused by abnormal development of blood vessels in the skin
- Typically appear at birth
- Usually occur on the face, neck, arms, or legs
- Do not fade over time As noted in the study on the diagnosis and management of infantile hemangioma 1, port wine stains are malformations made up of low-flow, thin-walled ectatic postcapillary venules, which distinguishes them from infantile hemangiomas. Treatment options for port wine stains include:
- Laser therapy: Pulsed dye laser treatment is the most effective method, as it was developed primarily for the treatment of port wine stains 1. Multiple sessions are typically required, starting in infancy or early childhood for best results.
- Cosmetic camouflage: Special makeup can be used to cover the birthmark
- Skin grafting: In severe cases, surgical removal and skin grafting may be considered It's essential to consult a dermatologist or vascular anomalies specialist for proper diagnosis and treatment planning, as early intervention with laser therapy can often lead to significant improvement in appearance and prevent potential complications like skin thickening or nodule formation that can occur with age.
From the Research
Definition and Characteristics of Port-Wine Stains
- Port-wine stains (PWS) are congenital vascular malformations characterized by ectatic capillaries and venules in the dermis, appearing as deep red to purple patches on the skin 2, 3, 4.
- They are the second most common congenital vascular malformation and can occur anywhere on the body, but often appear on the face, particularly in the area supplied by the trigeminal nerve 3.
- PWS can start as flat, pink, or red patches and may darken, thicken, and develop nodules over time, leading to cosmetic disfigurement and social stigma 3, 4.
Treatment Options for Port-Wine Stains
- Various treatment options are available, including lasers, cosmetic tattooing, electrotherapy, cryosurgery, derma-abrasion, and skin grafting, but none have been found to be completely satisfactory 4.
- Laser therapy, specifically pulsed dye laser (PDL), is considered the gold standard and most effective treatment for PWS, with significant improvement and minimal complications reported in several studies 2, 5, 6.
- The use of PDL has been shown to be safe and effective in treating PWS in patients with darker skin types, including African descent, with significant improvement and no complications reported 5.
Efficacy and Safety of Laser Therapy
- Studies have demonstrated the efficacy of PDL in reducing the redness of PWS, with more than 25% reduction in redness reported in 50-100% of participants after 1-3 treatments 6.
- Short-term side effects, such as pain, crusting, and blistering, have been reported, but long-term adverse effects, such as scarring and pigmentary alterations, are rare 6.
- High-quality randomized controlled trials (RCTs) are needed to assess the individual efficacy of different lasers and light sources, as well as participant satisfaction, to inform treatment decisions for PWS 6.