Port-Wine Stain

A port-wine stain is an abnormal collection of blood vessels in the skin. They are generally present at birth or appear shortly after birth. Another name for a port-wine stain is naevus flammeus. They are most commonly found on the face but can occur anywhere on the body. The incidence of port-wine stains is around 3-5 out of every 1000 births.

Port-wine stains are usually flat and light pink in color initially but gradually get darker with age. Eventually, many port-wine stains become dark purple and often become thick. They do not generally cause any symptoms such as pain but can bleed with minor trauma when they become raised.

Probably the most famous person with a port-wine stain was Mikhail Gorbachev, the former head of state of the Soviet Union, who had one on his frontal scalp and forehead.

Although port-wine stains do not normally increase in size, they do grow in proportion with the patient. They are benign and are not associated with cancer or other conditions unless the patient has one of a few congenital syndromes that are commonly associated with port-wine stains. Patients with Sturge-Weber Syndrome have a port-wine stain on their forehead and upper eyelid on one side only as well as seizures, glaucoma and abnormal mental development. Those with Klippel-Trenaunay Syndrome have port-wine stains and other abnormal blood vessels which contribute to the overgrowth of an extremity. The majority of patients with port-wine stains have isolated lesions with no associated syndrome.

The color of a port-wine stain is due to the fact that the lesion contains excess blood vessels and, therefore, has increased blood flow causing the skin to look pink, red or purple.

The most successful way to treat a port-wine stain is with a flash-lamp tunable-dye laser, however multiple treatments are generally required.

Port-wine stains are vascular lesions of the skin consisting of an abnormal collection of small blood vessels. This increased circulation results in the pink, red or purple color of the skin.

Various methods of treatment have been tried in the past, most of which have been unsuccessful. Most port-wine stains are large enough that surgical excision is not a viable option. Radiation with X-Rays was tried soon after it was developed only to be met with disastrous results. X-Rays do not target the vessels in the skin but damage the DNA of the cells much like years of excess sun exposure. This resulted in scarring and, eventually, a high incidence of various forms of skin cancer.

The first lasers used in medicine were tried with variable outcomes. CO₂ lasers were tried but mostly resulted in severe scarring without much elimination of the port-wine stain. Argon lasers were a little more successful but also caused significant scars and incomplete removal of the lesions.

It wasn’t until the late 1980’s when the concept of ‘selective photothermolysis’ was developed and the flash-lamp pulsed-dye laser was created that the blood vessels in the port-wine stains could be selectively targeted by the laser, allowing for removal of the lesion with minimal to no scarring. The wavelength of light created by this laser is relatively specifically absorbed by hemoglobin which is the pigment in blood giving it its red color. When the laser hits the skin of a port-wine stain, the laser energy is absorbed by hemoglobin and the light energy is converted to heat energy. The pigment in the blood within the port-wine stain is instantly heated to a point where some of the abnormal vessels are destroyed. When the area heals, usually in 7-10 days, the port-wine stain is slightly lighter in color. Multiple treatments are generally necessary.