What Can I Expect If I Have Nevus Flammeus
Port wine stains dont go away on their own. Without treatment, they will likely get larger. They also might get darker, thicker and bumpy.
For most people, these birthmarks are cosmetic and dont cause medical problems. But if you have a port wine stain, your healthcare provider should examine it from time to time.
Laser treatments may fade the birthmarks, but results vary widely. Even after successful treatments, nevus flammeus can come back or get dark again years later.
The Treatment Of Choice
The pulsed dye laser in conjunction with cryogen spray cooling is now the treatment of choice for PWS. Yellow light produced by the pulsed dye laser penetrates up to 2 mm into the skin and is preferentially absorbed by hemoglobin within the dilated PWS blood vessels. The heat within the vessel lumen causes blood vessel damage which is evidenced by intense purpura . Several treatment sessions spaced at 4-8 week intervals are required for maximum efficacy. The number of treatments required for maximum PWS fading can be variable and unpredictable. Treatment side effects are mainly limited to post-operative swelling and purpura, which generally resolves within 2 weeks. With the addition of cryogen spray cooling, the risks of scarring or changes in the normal skin pigmentation are minimal after pulsed dye laser therapy performed by an experienced physician.
We invite you to learn more about treating port wine stain in this rebuttal published by Dr. J. Stuart Nelson and Dr. Roy Geronemus in the New England Journal of Medicine.
Multiple pulsed dye laser devices are now available for PWS treatment, each with its own unique wavelength and pulse duration. Changing the wavelength or pulse duration of the laser can result in substantial PWS fading not previously observed with single device therapy. Moreover, several devices are sometimes used during an extended treatment protocol in order to destroy vessels of different sizes.
Hemangiomas And Your Skin
The hemangioma is a common type of vascular tumor that may occur early in life and resemble a birthmark. It is usually painless and harmless and its cause is not known. Color from the birthmark comes from the extensive development of blood vessels at the site.
Types of hemangiomas and birthmarks include:
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How Can I Help My Child Cope With A Port Wine Stain
A port wine stain can make a child self-conscious or embarrassed, especially if the birthmark is on the face. Some people might stare or make insensitive comments. To help your child, consider these strategies:
- Discuss the birthmark openly with your child, using simple language.
- Explain that the port wine stain is a unique, special, colorful part of them.
- Offer to try cover-up makeup if the child wants to minimize the mark.
- Discuss the port wine stain with the people your child interacts with frequently.
- Make sure teachers provide a supportive plan for your child to learn and socialize, free from bullying.
- Practice how to respond to people who ask about it. For example, Its just a birthmark.
- Treat the birthmark like any other personal characteristic, like eye color.
How Is A Port Wine Stain Treated
Port wine stains that arent associated with other medical concerns dont require medical treatment. But some people choose treatment because of:
- Increased risk of bleeding with trauma and associated risk of infections.
- Potential for thick, bumpy skin and disfigurement later in life.
- Self-esteem and socialization.
The most common treatment is laser therapy to shrink the blood vessels and fade the birthmark. The treatments are most effective in younger patients when the blood vessels are smaller.
Laser therapy treatments are brief, lasting a few minutes. Most people get repeat treatments every couple of months. The laser may make the skin red and sore, like a sunburn. If the treatments are very uncomfortable, you can ask for a numbing spray or cream. Very young children may even receive general anesthesia, so they sleep through the treatments.
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What Is The Difference Between A Port Wine Stain And A Birthmark
A port wine stain is actually a type of birthmark. However, most other types of birthmarks may not require treatment because they usually fade over time. Common birthmarks that do not involve capillary malformation found in PWSs include:
- Salmon Patchalso called anangel kiss or stork bite, the salmon patch birthmark is seen on nearly half of all babies born. Usually appearing on the forehead, back of the head neck or eyelids, a salmon patch is pinkish, irregularly shaped and harmless. Most fade by the time the child is five years old and do not need removed.
- Strawberry Hemangiomathis birthmark is rarer than port wine stains, occurring in about one out of every 400,000 births each year. Although a strawberry hemangioma may not be present at birth, it will emerge shortly after birth as a raised, red patch of skin resembling a strawberry in color and size. Although these vascular birthmarks enlarge rapidly during a babys first year, they are harmless and eventually disappear in about 70 percent of children affected by them. However, if a strawberry hemangioma is located in a visible areathe face or neck, for exampleit may need removed to prevent self-esteem issues from affecting the child if it does not fade in time.
What Are Capillaryvascularmalformations
Capillary vascular malformations are sometimes incorrectly referred to as flat haemangiomas. These are not haemangiomas but are malformed dilated blood vessels in the skin. Lesions are non-cancerous and appear as blotches of red or purple skin discolouration on any part of the body. They are always present at birth, although they may become more obvious with time. They may vary in size from a small dot to occasionally involving a whole limb, and they grow in proportion to the child’s general growth.
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Port Wine Stain Common Locations
Since most of the malformations occur on the face, PWS is a clinically significant problem in the great majority of patients. PWS should not be considered a cosmetic problem but a disease with potentially devastating psychological and physical complications. Detailed studies have documented lower self-esteem and problems with interpersonal relations in PWS patients.
Port Wine Stains / Vascular Birthmarks / Hemangiomas
Port Wine Stains
Vascular birthmarks called port wine stains affect about 3 in 1,000 children and are typically present at birth. Unfortunately, if left untreated, these vascular lesions do not go away on their own and may darken and thicken over a lifetime. PWS birthmarks may even develop small vascular “bumps” within them, which may bleed.
Our dermatologists are highly experienced in providing pulsed dye laser treatment for PWS birthmarks in patients of all ages. At your initial appointment, your physician will explain our treatment approach.
Most patients are treated within the Cosmetic Dermatology & Laser Center office, with treatment provided over a period of just a few minutes. For certain younger patients, we work with the Pediatric Anesthesia team to provide “pain-free” treatment under sedation in the C.S. Mott Children’s Hospital.
Although treatment of port wine stains is encouraged as early in life as possible, it is never too late to minimize a PWS birthmark. Patients whose prior treatment was unsuccessful may enjoy substantial benefits from current laser treatments.
Hemangiomas
In addition, Dr. Jennifer Mancuso and Dr. Jeffrey Orringer offer laser treatment for hemangiomas which bleed or develop open sores in infants and children.
Make an Appointment
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What Is The Treatment Of Capillary Vascular Malformation
Salmon patches require no treatment, whilst treatment of port wine stains depends on the body site, extent and nature of the lesion. In the past, a cosmetic cover was the best advice for those affected, but now many can be successfully removed or their appearance improved by laser treatment. Specialist advice and referral for treatment are best before school entry, when possible.
The pulsed dye laser appears to be the treatment of choice for most port-wine stains. Approximately 4045% improve by at least 75% after 5 to 25 treatments. Some lesions that do not respond to a PDL may improve when treated with other types of laser.
Capillary vascular malformations may bleed after minor trauma and sometimes the bleeding can be difficult to stop despite the application of pressure. This is uncommon.
Complex syndromes require careful assessment, often by a team of specialists that may include a paediatricdermatologist, paediatrician, radiologist, plastic surgeon and/or vascular surgeon. The following measures may rarely be necessary:
- Compression stockings or bandaging to reduce swelling and protect from injury
- Aspirin, and sometimes anticoagulants such as warfarin, to prevent clots
- Resection or ligation of abnormal blood vessels
- Sclerotherapy to treat varicosities
- Bone shortening operation if a limb is more than 2 cm longer than its pair
- Amputation of a very abnormal digit or limb
Effect of laser treatment on a vascular malformation
What Are The Signs Of Port
Port-wine stains can be anywhere on the body, but most commonly are on the face, neck, scalp, arms, or legs. They can be any size, and usually grow in proportion as a child grows.
They often change in texture over time too. Early on, they’re smooth and flat, but they may thicken and feel like pebbles under the skin during adulthood.
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Growing Up With A Port Wine Stain
Many people with a port wine stain will receive laser treatment in childhood. After a small test is carried out to determine how an individual will react to this treatment, children embark on a number of laser therapy sessions.
Such procedures consist of a laser sending a beam of light to the affected area of skin and heating this up in order to reduce the redness and prominence of the port wine stains appearance. A successful series of treatments will see the port wine stain fade in colour and become less visible to the eye. Some people even choose to use cosmetic camouflage on a daily basis to further cover up the appearance of the stain.
If port wine stains arent treated as they should be during childhood, it may be harder to reduce the deeper colours and effects of these in adulthood. Regardless of early treatment, port wine stains can also develop further nuances as those affected grow older. In some cases, port wine stains can deepen in colour and play host to raised bumps. Blood vessel blisters, also known as papules, can appear on the port wine stain, making this area prone to bleeding. This change in appearance may necessitate further laser treatment or surgery.
Other Capillary Vascular Malformations
Reticulate vascular naevi are closely related to port-wine stains. The main difference is that reticulate naevi usually spontaneously improve by fading with time.
Reticulate vascular naevus
Angiokeratoma circumscriptum is a raised warty dark red-purple lesion that is most commonly found on the lower leg or foot. It is often covered with rough scaly patches of skin. In many cases, they are present at birth but may also develop in childhood or adulthood. Angiokeratomas are mostly harmless vascular lesions that usually do not require treatment.
Angiokeratoma circumscriptum
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Do Birthmarks Need To Be Treated
Most birthmarks need no treatment. They usually remain stable as a child grows older. However, some areas that can resemble blood vessel tumors — called hemangiomas — may need treatment because of their location. For example, a raised hemangioma near a child’s eye may interfere with their ability to see. In rare cases, birthmarks are associated with other conditions, such as growths in the liver, lungs, stomach, or intestines.
Willingness To Pay For Treatment
Patients with facial PWS were willing to pay 11.8% of their monthly income and would offer a mean value of 1.2 hours per day for an imaginary therapy leading to a complete cure of their skin problem.25 It was reported that females with PWS are more willing to undergo experimental treatments and accept intravenous administration.2 These findings can be useful in evaluating the expected compliance of patients to a possible new treatment modality.
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How Would A Doctor Diagnose A Port
There is no particular test for a port-wine stain.
- The diagnosis is made on the appearance of a newborn’s skin.
- A biopsy is not normally necessary.
- A port-wine stain should not be confused with a ‘salmon patch’ or ‘stork mark’ that almost half of babies have, on the back of their neck in the midline. This fades over about a year and is entirely harmless.
Article Medically Reviewed By Dr Gavin Chan
Templestowe Lower and Berwick Clinics
Dr. Gavin Chan has a background in intensive care, anaesthesia, and emergency medicine. Since 2004, Dr. Chan has provided cosmetic procedures, including anti-wrinkle injections, dermal fillers, liposuction, fat transfer, skin needling, and laser treatments. He is a doctor trainer for various dermal fillers and anti-wrinkle injections. Read More
Have you got a port wine stain birthmark on your face or body that is bothering you? While some can be covered up with makeup or clothing, if youre unable to do so it may be time to consider treating them. They will not disappear by themselves or reduce in size over time. And as you get older the lesions can become raised and thickened. A Port wine stain birthmark cant be completely removed, but they can be treated so their appearance fades.
When you decide to have your birthmark removed its important to visit a reputable medical clinic that has highly trained and experienced Cosmetic Doctors and Cosmetic Nurses performing this treatment. Led by Dr Gavin Chan, since 2005 our team of Cosmetic Doctors and Cosmetic Nurses have effectively treated thousands of people with port wine stains.
What are port wine stain birthmarks?
Port wine stains are birthmarks that occur because of a congenital malformation of the capillaries and veins of the skin. They appear as a reddish/purple colour and have the appearance of wine stains. In some cases raised nodules can form within the affected area.
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Facts About Port Wine Stains
Research indicates that aggressively treating port wine stains as soon as possible facilitates eradication of PWS when it is eventually treated. Children possess lesser amounts of epidermal melanin than adults, which promotes the ability of laser therapy to eliminate port wine stains. Because melanin tends to absorb laser light energy, adults with port wine stains and extra melanin naturally inhibit the efficacy of laser therapy needed to evaporate damaged capillaries. Moreover, young children also have less skin collagen, a substance that also restricts the ability of laser light to spread throughout the port wine stain.
Possible Complications From Port Wine Stains
Gaining their common name from the purplish or reddish patch of skin that signifies this type of capillary malformation, Port Wine Stains occur in about 1 in 300 newborns. Classified under the general category of venous malformations, Port Wine Stains occur when small blood vessels form close to the surface during early development in the womb.
This is commonly attributed to genetic abnormalities during fetal development. No conditions or activities a women may endure during birth are known to contribute to this condition. Port Wine Stains may be small, large, light in color or dark most commonly, they appear on the neck or face and begin as a light coloration but grow darker over time.
Most Port Wine Stain birthmarks pose no medical risks or problems, although there is a cosmetic impact to consider. When this mark is large or located in highly visible areas, as on the face or neck, laser treatments can be used to lighten its aesthetic impact. Several treatments may be required to achieve the desired effect.
In rare cases, some Port Wine Stains may indicate other underlying conditions or complications. This is why any birthmark or Port Wine Stain should be examined by a specialist as early as possible.
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What Happens To Port
Unlike some other birthmarks, such as a “stork bite” or “strawberry,” a port-wine stain grows as the child grows. The birthmark will last into adulthood. The color usually gets darker, turning purple or a deep red. The skin of a port-wine stain often gets thicker, and it may go from feeling smooth to pebbly.
The birthmark shouldn’t itch or hurt, and it shouldn’t bleed. If it does, you should have it checked by a doctor. Sometimes, a port-wine stain gets drier than the skin around it, and using moisturizer will help.
Port-wine stains around an eye or on an eyelid might cause glaucoma, which can lead to blindness.
Reflectance Spectrophotometers And Tristimulus Colorimeters
Presence and degree of pre and post-treatment erythema is one of the widely used clinical indicators of PWS skin . Commercial devices, such as reflectance spectrophotometers and tristimulus colorimeters, provide quantitative measurements of erythema and melanin content in PWS skin.
Reflectance spectrophotometry is the most established and widely used technique for the objective assessment of PWS . Spectrophotometry generally entails the measurement of the wavelength dependent transmission properties of a particular material. A spectrometer is used on the detection end, to measure light over the visible and near-infrared portions of the electromagnetic spectrum .
Tristimulus devices present results in color space, which is a way of describing a given color using a predetermined set of characteristics, or dimensions. This is simple to use and interpret and more sensitive to changes in redness . Tristimulus devices produce a direct measurement of skin color, but are limited due to errors associated with spectral surface reflectance and the effects of skin chromophores such as melanin, which interferes with quantitative assessment of hemoglobin .
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