Port Wine Stain Birthmark
What Is A Port Wine Stain Birthmark?
A port wine stain is permanent vascular birthmark that usually presents as a large flat patch of purple or dark red skin with well-defined borders that is present right at birth. Generally, they appear on one side of the body, with the majority occurring on the face. Unlike infantile hemangiomas, port wine stains will NOT regress and fade spontaneously. Conversely, they can become darker and develop a bumpy surface with vascular blebs (bumps) overtime. In addition, when port-wine stains are located around the eyes, they can be associated with Sturge-Weber syndrome, which requires further medical evaluation. For port wine stains involving the upper eyelid, there can be a risk of ocular complications and therefore a referral to an Ophthalmologist will be required.
The physical changes and a port-wine stain’s cosmetic appearance can cause both medical problems and emotional stress for both the patient and their family. Therefore, early treatment is recommended. Not only is it recommended to improve the cosmetic appearance, but more importantly to prevent further medical complications in the future.
Port Wine Stain Treatment
The V Beam Perfecta 595nm pulsed-dye laser produces laser energy that targets hemoglobin in red blood cells. It is the gold standard for the treatment of port-wine stains. This is a non-ablative laser (does not cut the surface of the skin) that uses the selected wavelength of laser light to target the hemoglobin in blood. The blood then absorbs the energy causing the vessel to collapse. This allows the color to fade and helps to prevent the thickening that can occur overtime.
V Beam is not painful enough to require general anesthesia. The short pulses feel like cold and hot snaps on the skin, similar to an elastic band. A stream of cold air directed at the treated area helps to minimize discomfort. When treating infants or children, they of course cry during the treatment, but inevitably stop immediately once the treatment is completed. This confirms the belief that the pain is transient and they are more upset because they are being held tight and their eyes are being covered. However, pre-treating children with Tylenol or Advil one hour before the treatment can help with the discomfort.
A circular spot is used to deliver the energy, so circles of treated skin may be visible following the treatment. As we are using quick burst of energy to deliver the pulses, bruising will occur. This is the desired and expected response to the treatment. By constricting the vessels quickly, they are more likely respond. Dark black or purple bruising may be present for 2-3 weeks following the procedure. Occasionally small blisters or crusts may appear which may be kept moist with ointment while they heal. Although the bruising and crusting may be a nuisance, the skin will always heal completely.
Power Wine Treatment Results
In general, port-wine stains on the face will improve by 70-80% after 8-12 treatments. However, birthmarks off the face and especially those on the lower extremities, do not respond as readily. In these areas, a more realistic expectation would be a 40-50% level of improvement after 10-12 treatments. Our goal is not to completely eliminate the birthmark, but to make it less noticeable and to reduce the risk of thickening or vascular blebs in the future. In addition, birthmarks in adults that have not been previously treated are much less likely to respond. Adult birthmarks and those found off the face may need long-term maintenance treatments.