Port-wine stains are red or purple marks, often on the face. They are caused by a localised area of abnormal blood vessels (capillaries). Treatment with lasers can give good results although complete clearance is rare. 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 mark on the skin. It is usually present from birth. About 3 in 1,000 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-like appearance).
The pictures below show a rather large port wine stain in a baby and a smaller one in an adult. Notice the colour is much lighter in the baby compared to the adult, as port wine stains tend to darken with age.
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 wide (dilated). 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.
Although the vast majority of port wine stains are present at birth, they can occasionally develop later on. Possible causes include long-term exposure to ultraviolet light, other types of skin damage and changes in hormone levels. (Hormones are the chemicals that control the way the body works.) Infections, rare brain tumours and conditions affecting the blood vessels inside the body may also be involved.
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.
- Spine abnormalities and varicose veins: can be other associated problems.
The majority of children with port-wine stains do not have these complications.
How are port-wine stains diagnosed?
Port-wine stains are usually diagnosed on sight as their appearance is so typical. Occasionally scans and other tests are required to rule out some of the other complications such as brain and eye involvement.
What is the treatment for port-wine stains?
Port-wine stains may improve with time but never disappear completely. Laser treatment is usually the treatment of choice for port-wine stains, especially in children.
Treatment with a laser leads to variable improvement. A special fine laser can destroy the tiny widened (dilated) 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 2 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 ten 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 the age of 5 years.
- There may be pain, bruising and swelling over the treated area for a while after each session.
- If lasers don't work, surgery is sometimes required.
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. Changing Faces provides 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 & information
Dr Tim Kenny
Dr Laurence Knott
Dr John Cox