Port Wine Stains represent a congenital malformation of the superficial dermal capillaries.
Most of them are superficial and first present as a sharply demarcated pink patch, most often found in the areas of the head and neck in 90% of patients, and most often found in the distribution of the first and second trigeminal nerves. There are two types of vascular abnormalities: Type 1, in which the lesions are more superficial and therefore more amenable to treatment, and Type 2, which are deeper vascular lesions with greater degrees of anastomosis or connections with other vessels.
Some of the patients born with Port Wine Stain may have associated problems such as glaucomas, seizures, and or mental retardation, while others have an inflammatory component to their Port Wine Stain, which resembles a dermatitis because of the scaling, oozing, excoriations and crusting. Many of these patients are treated with steroids with fair results, but the PDL (Pulse Dye Laser) is curative after one treatment.
Many only have the vascular abnormality without any other organ compromise.
There are multiple therapeutic methods that have been used over time for the lesions of Port Wine Stain.
Many of them have been discontinued because of unacceptably high complications and other problems, such as scarring.
The treatment of children's Port Wine Stains, as well as that in adults has been gratifying with the use of PDL. Clinical experience with the use of the PDL and other lasers like the Yag, predict about a 10% clearance of the Port Wine Stain with each of the first five or six treatments. Additional treatments result in a decreased therapeutic response, so in order to obtain a 90% clearing of the lesion, the patient requires around twenty treatments.
With the IPL (Intense Pulsed Light), multiple studies have shown enhanced efficacy of clearing of the lesions, compared with the PDL.
Some of the most common adverse effects of vascular lasers are pigmentary changes in the form of hypopigmentation, which can occur in treated areas in dark-skinned patients treated with the PDL. Persistent hypopigmentation is more common on the neck, legs and chest; or persistent hyperpigmentation which can also occur with premature sun exposure on facial areas and after treatment of vascular lesions on the leg.
The use of depigmenting agents such as hydroxyquinone, alpha-hydroxy acids, azelaic acid and kojic acid, either alone or in combination with retinoic acid may be helpful. Fortunately, permanent scars or pigmentary changes are very rare, and hypopigmentation changes for example, tend to spontaneously resolve within 6-12 months.
More serious potential adverse events include atrophic and hypertrophic scarring and keloid formation.