Frequently Asked Questions

Port Wine Stains (Large Vessel Birthmarks)

Question: What can you do about children who have large blood vessel birthmarks?

February 19, 2008 - Laser treatment of port wine stains (PWSs) is safe and effective, but laser treatment of hemangiomas remains controversial, according to a review of laser treatment of pediatric vascular lesions reported in the February issue of the Journal of the American Academy of Dermatology.

"The pulsed dye laser (PDL) was the first laser developed with selective photothermolysis in mind," write Meghan F. Stier, BS, from SkinCare Doctors in Cambridge, Massachusetts, and colleagues. "It avoided the nonspecific thermal damage caused by previous lasers by matching the laser wavelength to the wavelengths absorbed by target chromophores, [which] enabled the PDL to specifically target particular tissues. Today, the PDL is the gold standard for the treatment of PWSs, but an optimal laser treatment for hemangiomas has yet to be discovered."

Based on their literature review, the authors discuss how to differentiate PWSs from hemangiomas, as well as the advantages, disadvantages, potential complications, and limitations of laser treatment for each of these lesions. Although their review does not attempt to be a comprehensive summary of all studies to date, it focuses on those studies showing either promising results or the limitations of laser treatment for PWSs and for hemangiomas.

The bottom line message seems to be that for flat, pink birthmarks, the pulsed dye laser is excellent in removing the birthmark, even in babies. The same laser is helpful for the darker and deeper red birthmarks, but these skin lesions will tend to recur over time. Many more laser sessions will usually be required for these birthmarks. In all the cases, the laser is very safe.

Darker-skinned patients may have skin sloughing after treatment, requiring wound care and causing pigmentary changes. They should wait up to 3 to 6 months between sessions to allow postinflammatory hyperpigmentation to resolve.

PWSs on the head and neck, especially in the periorbital area and lateral facial cheeks, respond much better to laser treatment than do those on the trunk and lower extremities.

Laser treatment appears to be helpful for superficial involuting and ulcerating hemangiomas, but not for those hemangiomas with deeper components, creating controversy regarding the use of laser therapy for these lesions. Potential side effects of the PDL on the lesions must also be considered.

"Pediatric vascular lesions can be medically threatening and psychologically distressing to patients," the authors write. "Overall, [PWS] laser treatment promoted notable clearing with low side effects, whereas hemangioma laser treatment provided inconsistent benefits and severe side effects occasionally. Laser treatment of [PWSs] is safe and effective, but laser treatment of hemangiomas remains controversial and is best for lesions without deeper components."

J Am Acad Dermatol. 2008;58(2):261-285.

Click here for more information on laser treatment for port wine stains.

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