What is a capillary malformation or ‘port wine stain’?

Capillary malformations or ‘port wine stains’ are flaws in the construction of capillaries. Beneath the epidermis a localised abundance of capillaries occurs. These tiny vessels have widened beyond what is normal. You can see them through the skin as a reddish patch, often resembling a geographical pattern: the so-called ‘port wine stain’. Being innocuous in itself, a port wine stain can mar a person’s looks. Sometimes these birthmarks are an indication of anomalies in veins, lymph vessels or arteries. Only very rarely do port wine stains coincide with other congenital defects.

Capillary malformations (port wine stains) through time

Port wine stains are present from the day of birth. They develop in sync with the child’s growth and throughout will always cover the same percentage of skin surface. In the course of time the vessels can further swell up, which may give this birthmark a blue-purple discoloration and an uneven surface. These spots could become vulnerable, as a result of which bleeding may occur.

Laser treatment of birthmarks

Nowadays another way of treatment of port wine stains is performed by using lasers or IPL flashlamps (IPL: Intense Pulsed Light treatment). A laser is a very powerful source of light of one specific colour, i.e. of one constant wavelength only. Every type of laser has its own colour. In the treatment of a port wine stain a colour of light is chosen that the targeted capillaries will absorb. Consequently only these tiny blood vessels heat up and are burnt away from the inside, so to speak, while other skin tissue remains largely unscathed. Different kinds of lasers and flashlamps are in use:

  • pulsed dye laser
  • neodynium YAG-laser
  • argon laser
  • photoderm flashlamp

At the present time broad experience has been gained with laser treatment of port wine stains. A treatment programme starts off with a trial test on a small patch of the stained area, to establish whether treatment will be successful. From that point, multiple therapy sessions usually follow. The larger the wine stain, the more sessions follow. This treatment is mildly painful. The sensation of pain caused by a single laser beam is comparable to that of an elastic band shot against the skin. One laser beam only covers a small area of a few millimeters. This means that such treatment is impracticable for small children and in their case our advice is to postpone treatment. Medical grounds for treatment under anaesthetic are exceptional. However, laser treatment often proves to be the right option for bigger children (12 years and up). Incidentally, removal of wine stains at the baby age does not prevent some of the later consequences common in the disorder, such as thickening of the skin.

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