Port-wine stain treatments: The earlier the better

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For people with port-wine stain birthmarks, laser surgery is one way to soften the appearance.

Treatment can be uncomfortable, and in the past, some doctors recommended waiting until a child was a few years old and could better tolerate anesthesia.

But new improvements to laser devices mean, for some, the earlier the better.

Nineteen-month-old Riley Shehigian is in constant motion. But even in those rare times when she's still, it's hard to see the red birthmark she was born with covering the left side of her face.

"They said, 'Oh, it's just bruising from labor and birth,' but it didn't go away," said Chandra Shehigian, Riley's mother.

Dermatologists diagnosed the port-wine stain birthmark when Riley was 5 days old. Five days later, doctors began treatment.

"For her sake, we wanted to treat her, and we wanted to treat her young," said Grant Shehigian, Riley's father. "Hopefully, she won't remember what she went through."

Using a device called the V-Beam laser, doctors delivered quick pulses to the red area of Riley's face.

"The laser, it goes through the skin, heats up the blood," dermatologist Dr. Leonard Bernstein said. "That heat expands and destroys the lining of the vessel, hopefully destroying the vessel wall."

The laser allows doctors to treat a section about the size of a dime, and then repeat until they've lasered the entire birthmark.

"The treatment of an infant is safe, but it does have the feel of a rubber band snapping on the surface of the skin," Bernstein said.

Bernstein said the updated laser device makes treatment easier on patients since its faster with no need for anesthesia.

"The fact that someone can't recognize it. That's the goal. That's the hope," Grant Shehigian said.

Other treatments have been tried for the treatment of port-wine stains, including freezing, surgery and radiation. Doctors say laser therapy is the only one that destroys the malformed blood vessels without causing damage to the skin.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: PORT WINE STAIN TREATMENTS: THE EARLIER THE BETTER
REPORT: MB #4652

BACKGROUND: A port-wine stain is a type of birthmark that got its name because it 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 as kids grow. 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. They can also get very dry, bleed, hurt, itch, and become infected. (Source: https://kidshealth.org/en/parents/port-wine-stains.html)

TREATMENT: Although it can be useful for a child with a port-wine stain to see a specialist soon after birth, treatment does not usually start until later in infancy. There are currently two options for treating port-wine stains: laser treatment and cosmetic camouflage. Laser treatment with a pulsed dye laser, is currently the treatment of choice for fading a port wine stain. It may also help the 'cobblestone' effect that can develop in adulthood. When laser treatment is carried out at a specialist center with doctors who are experienced in dealing with vascular birthmarks in children, the results can be excellent and the side effects minimal. (Source: https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/port-wine-stains)

V-BEAM: Leonard Bernstein, MD, a Dermatologist at Laser and Skin Surgery Center of NY talked about the V-beam Prima, "The V-Beam is a laser that targets the hemoglobin within the blood vessel. The laser goes through the skin and heats up the blood. That heat expands and destroys in the lining of the vessel, hopefully destroys the vessel wall. The selectivity of the laser prevents us from injuring the surface of the skin so we can safely treat children of all skin color without injuring the surface of the skin." Dr. Bernstein said there has been debate about what age to treat affected children, "A lot of doctors will wait until age three or four to treat. When we treat at less than one year of age, the skin is relatively thin. The spot size of the area of involvement is relatively small as the child is small. Treatments are faster than treating a three-year-old. Treatment early is much more effective because we can treat a small area in a faster treatment session." (Source: Leonard Bernstein, MD)