Port wine stains (PWS) are common vascular birthmarks that present as a pink to red discoloration on the skin. The cause of this birthmark is not well understood. PWS can present on any area of the body and the majority are often located on the face. Depending upon the size and location (e.g., large facial near the eye), PWS may be associated with complications and the provider will discuss this topic with the family if applicable.
PWS remain constant thru life and grow proportionally with the child’s own growth. Over time, these areas tend to darken and thicken, often with the development of nodules and potential for anatomic disfigurement. We certainly agree with our colleagues and the Vascular Birthmark Foundation’s (www.birthmark.org) statement: “PWS should not be considered a cosmetic problem but a disease with potentially devastating psychological and physical complications”.
Pulsed dye laser therapy is considered to be the gold standard for the treatment of PWS as the wavelength of this laser specifically targets the hemoglobin within the vessels, causing selective vessel damage. Purple areas (i.e., purpura) are expected for 7-14 days following the procedure and can often be a good indicator of adequate laser energy for effectiveness.
In order to minimize the potential for increased thickness and nodular development of the PWS, it is best to begin laser therapy early to achieve the best results. In our practice, we usually start laser therapy at approximately 6 months of age, especially if general anesthesia is required, as this is generally considered a safe age for elective anesthesia. Several treatments are typically required for maximal improvement and are usually spaced out every 3 months (often dictated by insurance companies).
Currently, our PWS patients are treated at the Cook Northeast Center (Hurst) with the Candela (V-Beam) pulsed dye laser equipped with a cryogen or dynamic cooling device (DCD). With the addition of the DCD, the risks of scarring or skin changes are significantly decreased.
Dr. Ghali has over 15 years of experience in the treatment of PWS with pulsed dye laser therapy. He works closely with pediatric radiologists, plastic surgeons, ophthalmologists, and other pediatric specialists in the management of PWS and other related vascular birthmarks.