Port-wine stain
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A port-wine stain (nevus flammeus) is a discoloration of the human skin caused by a vascular anomaly (a capillary malformation in the skin).<ref name=CC-Faurschou>Template:Cite journal</ref> They are so named for their coloration, which is similar in color to port wine, a fortified red wine from Portugal.
A port-wine stain is a capillary malformation, seen at birth.<ref name=PCDS-Port-wine>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Port-wine stains persist throughout life.<ref name=Patel-2012>Template:Cite journal</ref> The area of skin affected grows in proportion to general growth.
Port-wine stains occur most often on the face but can appear anywhere on the body, particularly on the neck, upper trunk, arms and legs.<ref name=PCDS-Port-wine /><ref>Template:Cite journal</ref> Early stains are usually flat and pink in appearance. As the child matures, the color may deepen to a dark red or purplish color.<ref name=PCDS-Port-wine /> In adulthood, thickening of the lesion or the development of small lumps may occur.<ref name=PCDS-Port-wine /><ref>Template:Cite journal</ref>
Port-wine stains may be part of a syndrome such as Sturge–Weber syndrome or Klippel–Trénaunay–Weber syndrome.<ref name=PCDS-Port-wine />
Types
Nevus flammeus may be divided as follows:<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 582–3. Template:ISBN.</ref>
- Nevus flammeus nuchae
- Midline nevus flammeus - also known as salmon patch and angel's kiss, is a vascular birthmark which may be found on the glabellar region or on one upper eyelid, and presents in approximately 15% of newborns.<ref name="Andrews/">Template:DorlandsDict</ref>
Genetics
Port-wine stains were shown to be caused by a somatic activating c.548G→A mutation in the GNAQ gene.<ref>Template:Cite journal</ref> An association with RASA1 has also been described.<ref name="pmid14639529">Template:Cite journal</ref>
Diagnosis
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A healthcare provider can usually diagnose a port-wine stain based entirely upon the history and appearance. In unusual cases, a skin biopsy may be needed to confirm the diagnosis. Depending on the location of the birthmark and other associated symptoms, a physician may choose to order a measurement of intraocular pressure or X-ray of the skull.
An MRI of the brain may be performed (under anesthesia) on infants who have a port-wine stain in the head area in order to check for signs of Sturge–Weber syndrome.<ref name=PCDS-Port-wine />
If the port-wine stain is inside the mouth, a provider may check the insides of a newborn baby's throat with a scope to see if there are any changes (growths) other than just the color.
If the port-wine stain is around the eye or on the eyelid, a referral may be made to an optometrist or ophthalmologist for a test of the ocular pressures in that eye. If swelling occurs in the port-wine stain, it may cause vision problems, glaucoma, or blindness.
Treatment
Many treatments have been tried for port-wine stains including freezing, surgery, radiation, and tattooing; port-wine stains can also be covered with cosmetics.
Lasers may be able to destroy the capillaries without significant damage to the overlying skin. Lasers and other light sources may therefore be able to reduce the redness of port-wine stains, although there is not enough evidence to recommend one form over another.
For most people in trials of pulsed dye laser, more than 25% of the redness was reduced by laser after one to three treatments. Adverse effects were rare in these trials, although some people had changes to the color of the skin, especially Chinese people with darker skin. There can be pain, crusting, and blistering in the two weeks after treatment. The trials only followed people for six months, so long-term outcomes are not known.<ref name=CC-Faurschou /> Up to 10 treatments may be necessary for improvement, but complete removal may not result.<ref name=Patel-2012 /> The use of topical rapamycin as an adjunct to pulsed dye laser may improve results.<ref>Marques L, Nunez-Cordoba JM, Aguado L, et al. Topical rapamycin combined with pulsed dye laser in the treatment of capillary vascular malformations in Sturge-Weber syndrome: phase II, randomized double-blind, intraindividual placebo controlled trial. JAAD 2015.</ref>
Treatment is generally given before one year of age.<ref>Template:Cite journal</ref>
Prognosis
In the absence of successful treatment, hypertrophy (increased tissue mass) of the stains may cause problems later in life, such as loss of function (especially if the stain is near the eye or mouth), bleeding, and increasing disfigurement. Lesions on or near the eyelid can be associated with glaucoma.<ref name=PCDS-Port-wine /> If the port-wine stain is on the face or other highly visible part of the body, its presence can also cause emotional and social problems for the affected person.
Epidemiology
Studies have recorded an incidence of about 3–5 cases per 1,000 newborn babies.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Dr Thajudheen MD (Dr Thaj laser skin hair clinic), Kannangath Jyothy, Arul Priyadarshini, "Treatment of port-wine stains with flash lamp pumped pulsed dye laser on Indian skin: A six year study", Dr. Thaj Laser Skin-Hair Clinic, 2 April 2014</ref>
References
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