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