About Port-Wine Stains
About 3 out of every 1,000 kids are born with a port-wine stain
- a birthmark that literally looks like maroon wine was spilled or
splashed on the skin. Though they often start out looking pink at
birth, port-wine stains tend to become darker (usually
reddish-purple or dark red) as kids grow.
Port-wine stains (also known as
nevus flammeus
) can be anywhere on the body but most commonly are found on
the face, neck, scalp, arms, or legs. They can be any size, and
usually grow in proportion with a child. 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.
For most kids, port-wine stains are no big deal - they're
just part of who they are. And some port-wine stains are barely
noticeable, especially when they're located somewhere other
than the face.
But port-wine stains often get darker and can sometimes become
disfiguring and embarrassing for children. Port-wine stains
(especially on the face) can make kids feel self-conscious,
particularly during the already challenging preteen and teen years
when kids are often more interested in blending in than standing
out.
Although port-wine stains won't go away on their own, they
can
be treated. In fact, laser therapies can make many port-wine stains
much less noticeable and give kids' self-esteem a much-needed
boost.
Cause
Port-wine stains happen when an area of skin doesn't get any
(or an insufficient) supply of nerve fibers, which normally help
keep blood vessels narrow. When there's a lack of nerve fibers,
small blood vessels (called
capillaries
) keep expanding, allowing a greater amount of blood to flow into
the blood vessels, causing a stain to form under the skin.
Birthmarks that form like this are called
vascular birthmarks
.
Port-wine stains
can't
be prevented - and they're
not
caused by anything a mother did during pregnancy.
Diagnosis
Your doctor can sometimes tell if your child has a port-wine
stain or a different kind of vascular birthmark by looking at your
child's skin.
Vascular birthmarks called
macular stains
(also known as salmon patches, angel kisses, or stork bites) may
resemble port-wine stains. They're faint red marks often found
on the forehead or eyelids, the back of the neck, or on the nose,
upper lip, or on the back of the head. These often fade on their
own by the time a child is 1 to 2 years old.
Port-wine stains also may be confused with
hemangiomas
. Superficial (formerly called "strawberry") hemangiomas
are bright red, raised birthmarks. Deep hemangiomas (once called
"cavernous") are a bluish-red, puffier birthmark.
Hemangiomas, which are also found on the head or neck, grow quickly
during infants' first 6 months or so, but usually shrink back
and disappear by the time a child is 5 to 9 years old.
Port-wine stains are usually nothing more than a harmless
birthmark that doesn't cause any problems or pain. However,
they're sometimes (though very rarely) a sign of other medical
conditions.
For example, port-wine stains on or near the eye or on the
forehead need to be monitored. That's because they may be
associated with a sort of "stain on the brain" (a very
uncommon neurological disorder called
Sturge-Weber Syndrome
that causes problems like seizures, developmental delays, and
learning disabilities). Stains on the eyelids may also, rarely,
lead to
glaucoma
- increased pressure inside the eye that can affect vision and lead
to blindness if left untreated.
If there's a concern about the location of a port-wine stain
or accompanying symptoms, your doctor may order tests (such as eye
tests or imaging tests like an X-ray, CT scan, or MRI) to see
what's going on and rule out an underlying problem. If your
child has a birthmark
anywhere
on the body it's important for your doctor examine it to
see what type it is and what kind of monitoring and treatment it
needs, if any.
Treatment
Although some port-wine stains are small and hard to see, some
can be really upsetting for kids, especially if they're large,
dark, or on the face. And any birthmark can take a toll on a
child's self-confidence, no matter how large or small the mark
might be.
The good news is that lasers (highly concentrated light energy)
can make many kids' port-wine stains much lighter, especially
when the birthmark is on the head or neck. Dermatologist or plastic
surgeons usually give several treatments with the laser of choice
for port-wine stains called a
"pulsed-dye" laser
.
Laser treatment is often started in infancy when the stain and
the blood vessels are smaller and the birthmark is much easier to
treat. But that doesn't mean laser treatments can't help
older kids or teens, too - it's just that the longer someone
has had the stain, the harder it might be to successfully treat
it.
Laser therapy doesn't hurt a lot, but can be uncomfortable.
During the treatment, kids can usually be given an anesthetic
(given as a shot, spray, or ointment to numb the area to so it
doesn't hurt as much). Young kids may also be given general
anesthesia to help them sleep or relax during the procedure. After
treatment, the area might be swollen and bruised at first, but it
will be back to normal in 7 to 10 days.
For port-wine stains that have become bumpy, thick, or raised,
doctors sometimes need to use another type of laser or surgery.
Port-wine stains can also develop grape-like growths of small blood
vessels called
vascular blebs
- these aren't usually cause for concern but they often bleed
and may need to be removed.
In the past some people have opted for other treatments, too
(like freezing, tattooing, even radiation). But these aren't as
effective -
or
as safe - as laser therapy. Laser surgery is the
only
treatment that works on port-wine stains with less risk of damaging
or scarring the skin. Sometimes, though, laser treatments may make
the area look lighter or darker than normal, although this usually
is just temporary.
And laser treatments may not get rid of the birthmark entirely
(though a few kids' birthmarks do disappear altogether after
treatment). Plus, over time the birthmark may come back and need to
be retreated.
For a small number of kids, laser treatment might not work at
all. Every child's port-wine stain is different, so whether or
not the treatment works well will be different for each child,
too.
Care
Port-wine stains can get very dry sometimes, so it's
important to use a moisturizer. Also be sure to call the doctor if
your child's port-wine stain ever bleeds, hurts, itches, or
becomes infected. Like any injury where there's bleeding, make
sure to clean the wound with soap and water and use a gauze bandage
to place firm pressure on the area until the bleeding stops. If the
bleeding
doesn't
stop, call your doctor.
If your child's port-wine stain has been treated with laser
surgery, avoid rubbing or scratching the area, and gently cleanse
it with lukewarm water. Your doctor may prescribe an ointment to
aid in healing and help prevent infection.
Helping Kids Cope
As with any birthmark, port-wine stains (especially on the face)
can make kids feel different and insecure about how they look. If
it's clearly visible, people might ask questions or stare,
which can be hurtful for both you and your child. Even at a young
age, kids watch how their parents respond to these situations
and take cues about how to cope with others' reactions.
Practice responses so your child will feel more prepared when
asked about it. It can help to have a simple, calm, nonchalant
explanation ready like, "It's just a birthmark. I was born
with it."
Talking simply and openly about a birthmark with kids makes
them more likely to accept it as just another part of themselves -
like their height or eye color. It's also important,
emotionally, for kids to be around supportive family and friends
who treat them like everyone else.
Of course, it's still natural for kids to want to do
whatever they can to minimize a birthmark. In addition to laser
treatments, special cover-up makeup can camouflage the stain and
make living with it a little easier.
Still, kids with port-wine stains (or any birthmark, really)
need to know that they're no different from other kids. If
anything, it may help to tell your child that kids born with a
port-wine stain are unique in a
good
way - it's a special, colorful part of themselves that few
other people have.
Reviewed by:
Patrice Hyde, MD
Date reviewed: March 2009
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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