Port-wine Stain

What is a port-wine stain?

A port-wine stain is a red or purple mark on the skin. It is usually 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. Port-wine stains affect males and females equally. They are not hereditary.

What do port-wine stains look like?

Port-wine stains vary in size from a few millimetres across to many centimetres. 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 can become thickened and lumpy (a 'cobblestone' appearance).

What causes port-wine stains?

A port-wine stain is a localised blood vessel problem. The tiny blood vessels (capillaries) in port-wine stains remain dilated (wide). It is like a permanent localised blush. 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 narrower are lost so they 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.

• Eye problems may develop if the port-wine stain is on the eyelid area. 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.

The majority of children with port-wine stains do not have these complications.

What is the treatment for port-wine stains?

Occasionally, port-wine stains improve and fade without treatment, particularly when the forehead and eyelids are affected. Laser treatment is usually the treatment of choice for port-wine stains, especially in children.

Laser treatment

Treatment with a laser leads to variable improvement. A special fine laser can destroy the tiny widened blood vessels. Laser treatment may not clear the port-wine stain completely and repeat treatments are often needed over the years to come. Features of laser treatment include the following.

• Treatment works best in young children when the port-wine stain is new and flat. Children as young as two months old can be treated. 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 smaller port-wine stains of the face and less well on the arms and legs.
• Generally, the paler the port-wine stain, the greater the chance of excellent results.
• The laser can cause an unpleasant stinging. Therefore, younger children usually have laser treatment under a general anaesthetic or with sedation. Local anaesthetic is normally sufficient for older children and adults.
• Up to 10 treatments are needed depending on the size. Treatments are given about eight weeks apart. It is best to have completed all sessions before a child reaches five years.
• There may be pain, bruising and swelling over the treated area for a while after each session.

Skin camouflage

This is still 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, many people become very quick and skilled at putting on camouflage creams each day.

Further help and advice

The Birthmark Support Group

BM The Birthmark Support Group, London, WC1N 3XX
Tel: 0845 045 4700 Web: www.birthmarksupportgroup.org.uk
Offers information and support to anyone affected by a birthmark (including port-wine stain).

Red Cross Skin Camouflage Service

British Red Cross Association, British Red Cross, 44 Moorfields, London, EC2Y 9AL
Tel: 0844 871 11 11 Web www.redcross.org.uk
Aims to teach how to apply camouflage creams effectively.