Port Wine Stain

Port wine stains cause red or purple marks, often on the face. They are caused by a localised area of abnormal blood vessels. Treatment with modern lasers can give good or excellent results in most cases. Treatment in early childhood is best. Camouflage creams are an alternative treatment.

What is a port wine stain?

A port wine stain is a red or purple area of skin. It is present from birth. About 3 in 1000 babies are born with a port wine stain. Most occur on the face but any area of the skin can be affected.

What do port wine stains look like?

Port wine stains vary in size from a few millimetres across to many centimetres. There is a sharp line between the port wine stain and normal skin. Their colour can vary from pale red to deep purple. If left untreated, port wine stains tend to darken over the years as the blood flow through them becomes more sluggish. The overlying skin is smooth and flat at first. By middle age the overlying skin may become thickened and lumpy (a 'cobblestone' appearance).

What causes port wine stains?

A port wine stain is a localised blood vessel problem. Tiny blood vessels can normally narrow (constrict) or widen (dilate) depending on circumstances. This allows different amounts of blood to the skin surface. The more blood, the redder the skin. For example, normal skin goes pale when we are cold (blood vessels constrict) and goes bright red when we blush (blood vessels dilate).

The tiny blood vessels (capillaries) in port wine stains remain wide (dilated). It is like a permanent localised blush. The constant supply of extra blood makes the skin look red or purple. The reason why this occurs is thought to be due to a damaged or faulty nerve supply to the affected tiny blood vessels. The nerve impulses that make the blood vessels wider or narrower are lost. The tiny blood vessels then stay wide all the time.

What are the symptoms of port wine stains?

Apart from their appearance, no other symptoms or problems occur in most cases. However, about 1 in 10 babies born with a port wine stain on the face have problems of the eye or brain. (The port wine stain is then a 'marker' for a more serious problem.)

• Eye problems may develop if the port wine stain is next to the eye. Blood vessel abnormalities may also develop in the eye and cause glaucoma or other eye problems. If a child has a port wine stain next to an eye then an eye specialist will normally check the child regularly until they are adult.
• Brain abnormalities are an uncommon association with port wine stains of the face. This is due to extensive blood vessel abnormalities in the brain. (The Sturge-Weber syndrome.) Epilepsy and other problems may then develop.

But, as mentioned, most children with port wine stains do not have these complications.

What is the treatment for port wine stains?

Before modern laser treatment, covering the port wine stain with special camouflage creams was the only option. Modern laser treatment can now give very good results.

Laser treatment
A special fine laser can destroy the tiny widened blood vessels. Treatment may not clear the port wine stain completely. However, in over 6 in 10 cases there is good or excellent results from modern laser treatment. Features of laser treatment include the following.

• Treatment works best in young children when the port wine stain is new and flat. It works less well in adults who have had a port wine stain for a number of years which may have become bumpy and raised.
• Treatment tends to work best on port wine stains of the face, and less well on the arms and legs. Small port wine stains are easier to treat than large ones.
• As a rule, the paler the port wine stain, the greater the chance of excellent results.
• The laser can cause an unpleasant stinging. Therefore, it is used under general anaesthetic for children. Local anaesthetic may be sufficient for adults.
• Up to 10 treatments are needed depending on the size. Treatments are given about 8 weeks apart. It is best to have completed all sessions before a child reaches 5 years.
• There may be pain, bruising, and swelling over the treated area for a while after each session.
• Scarring is an uncommon side-effect with modern lasers. It used to be more of a problem with older lasers.

Skin camouflage
This is a common way of covering port wine stains. Special coloured cover creams can be put on port wine stains to improve the skin's appearance. The aim is to find a colour to match the normal skin. Some cover creams can be prescribed on the NHS. Camouflage creams can disguise port wine stains very well which may greatly increase self confidence. The British Red Cross provide a free Skin Camouflage Service (see below). After advice and instruction, some people become very quick and skilled at putting on camouflage creams each day.

Further help and advice

The Birthmark Support Group
P O Box 3932, Weymouth, Dorset, DT4 9YG
Tel: 01202 257703    Web: www.birthmarksupportgroup.org.uk
Offers information to anyone affected by a birthmark (including port wine stain). The website is regularly updated with the group's activities and provides links to other relevant organisations.

Red Cross Skin Camouflage Service
British Red Cross Association, 9 Grosvenor Crescent, London, SW1X 7EJ
Tel: 020 7235 5454    Web: www.redcross.org.uk
Aims to teach how to apply camouflage creams effectively and to enable people to feel more confident about their appearance.

© EMIS and PIP 2004   Updated: May 2004   CHIQ Accredited