What is a Port Wine Stain?
A Port Wine Stain (PWS) is a vascular birthmark caused by atypical development of blood vessels in the skin. This occurs during early pregnancy whilst the baby is still developing in the womb. This is not known to be related to anything that happens during pregnancy and is not inherited.
How does a PWS present?
A PWS is a red/purple mark on the skin that generally starts off flat but can become raised and thicker over time. They can appear anywhere on the body, although approximately 65% of PWS are on the head. They usually present on one side of the body but occasionally can appear on both sides.
How many people are affected?
Approximately three in every 1000 people will have a PWS, with girls being twice as likely as boys to have them. The reason for this is as yet unknown.
They are clearly visible and distinctive so no special diagnostic test is needed.
As previously stated most port wine stains affect the face, but they can involve any area of skin. They may be part of more widespread abnormalities that are generally checked out at birth, some of which are listed below:
- A PWS in the skin around the eye, may be associated with increased pressure in the eye (Gluacoma)
- A PWS on the upper face can be linked to abnormalities within the brain but this is rare (Sturge-Weber Syndrome)
- A PWS on the central back overlying the spine can be linked to an underlying spine defect (Spina bifida)
- If there is an enlargement of the limb affected by the PWS, it may also develop enlarged deeper varicose-type veins (Klippel-Trenaunay-Syndrome)
If you have any of these conditions, it will be necessary for your practitioner to liaise with your consultant to determine whether you are able to proceed with treatment.
What are the treatments available?
The main two treatments offered by the NHS are laser and cosmetic camouflage:
Laser is especially effective if started when the person is a young child, and they will need approximately 4-6 sessions over a period of a few years. This can reduce the PWS by approximately 70% on 75% of children (as stated by GOSH – Great Ormond Street Hospital).
From my experience of working with adults, the laser results are reduced in adulthood. However, some patients still recorded a reduction in the visibility and colour of the PWS over a number of sessions, ranging from 6-12. Other patients reported that they saw no change in the PWS – resulting in fewer treatments (ranging from 1-5).
Cosmetic Camouflage is a cream that doesn’t physically affect the PWS, but camouflages and blends it into the surrounding skin colour. If applied correctly Cosmetic Camouflage cream is waterproof and transference proof. It is worth taking advice from a Camouflage practitioner to find the correct colour match (this can take up to an hour) and to learn how to accurately apply it to utilise its long-lasting effect (up to 24 hours on the face, and 2-3 days on the body). Furthermore, many of my patients find that just having the option to conceal their PWS can help reduce anxiety and give an increase in confidence. The choice can be just as beneficial as the Camouflage.
Is Medical Tattooing indicated here?
Medical Tattooing is not used within the NHS for PWS. Until 2020 it was not used privately in the UK, however they have been using it as a form of treatment in France, The Netherlands, Japan and the USA.
What is the research?
The current research on Medical Tattooing for PWS is limited, but also encouraging. The research titled ‘Cosmetic tattooing as a treatment of Port-Wine Stains’ by Eddy M. Van Der Velden and Bert D. De Jong, M.D., PhD. wrote in their paper that ‘The results were excellent, the skin texture remained normal, and the patients could discontinue cosmetic camouflage.’ ‘Cosmetic Medical Tattooing when carefully done is a valuable addition to the medical armamentarium and may replace more aggressive techniques. Int J Dermatol 1993;32:372-375
What are the risks?
As with any injection site there is a small risk of infection, so following the aftercare is imperative to reduce this risk even further. On a few occasions the skin does not retain the pigment well, or the colour may heal differently than expected. This is not a long-term risk, and can be colour corrected at each treatment working over-time to achieve the best outcome.
What are the side effects?
The immediate side effects are bruising, slight swelling, redness, soreness and scabbing. Following the correct aftercare will ensure these are only short-term side effects.
Treatment may have a psychological impact especially if the PWS has caused emotional distress. A support system around you, whether this is family, friends or a professional, is advised to be put into place before treatment commences.
What are the benefits?
A reduction in visibility of the PWS can have a positive effect and relieve anxiety attributed to it.
Many patients report their confidence has greatly increased in social and work situations, creating a more rounded environment and lifestyle. Other benefits include:
Added time on a daily basis from no longer wearing cosmetic camouflage cream.
The pigment is semi-permanent so it will last between 1-5 years.
The treatment is safe and effective.
How many treatments are involved?
The number of treatments involved will be different for each person ranging from 2-15 depending on the size of the area and the retention of the pigment.
How long between treatments?
It’s necessary to leave a minimum of four weeks in between treatments.
How long is the healing time?
The area treated will take between 3-10 days for the scab to form and come away. The underneath lower layers of skin can take up to 3-4 weeks to heal but you will not notice this change.
Can you cover it in between treatments?
Yes, as soon as the scab comes away it is safe to use cosmetic camouflage cream on the area.
Does it hurt? Is it painful?
The treatment can be tender, and in some areas it will feel sore. Topical anaesethic is used to lessen the pain.
Do you need regular treatment?
An annual colour boost of one treatment is recommended to keep the area looking its best.
What can you expect from a treatment?
A treatment will range from 30 minutes to 3 hours depending on the size of the area and treatment plan.
What can you expect from the results after each treatment?
Results will vary from patient to patient. A change in colour will most likely be noticeable from the first treatment, but the coverage may be patchy. Some areas take multiple sessions before retaining the pigment. However, the PWS will never be gone, but it will be less visible and for some people that still want to use camouflage cream, it will be easier to cover.
What are the long-term effects?
You will NEVER be able to have any LASER treatments on the area tattooed, AT ANY TIME in the future. Laser can turn the pigment black, and even if you think the pigment has faded there will most likely be some remaining molecules that would change colour from the laser.
Can you tattoo children?
No, you cannot tattoo anyone until they are 18 years old. Even then, I find it imperative to offer alternatives such as cosmetic camouflage cream, and/or psychological help until at least 30 years old.
I hope this helps inform you better about what is involved in reducing the visibility of a PWS and the expectations. I’m always available on the phone or online for a consultation giving you the chance to ask any further questions.
If you would like to book a free of charge phone call or a full medical consultation please use this direct link to read the FAQ’s and book your appointment online with Rae Denman.