Port-Wine Stains

What Are Port-Wine Stains?

A port-wine stain is a type of birthmark. It 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 (usually reddish-purple or dark red) as kids grow.

Port-wine stains won't go away on their own, but they can be treated. Laser therapies can make many port-wine stains much less noticeable by shrinking the blood vessels in the birthmark and fading it.

What Are the Signs of Port-Wine Stains?

Port-wine stains (also known as nevus flammeus) can be anywhere on the body, but most commonly are on the face, neck, scalp, arms, or legs. They can be any size, and usually grow in proportion as a child grows.

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.

What Problems Can Happen?

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 not on 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.

Can Port-Wine Stains Be Prevented?

Port-wine stains can't be prevented. They're not caused by anything a mother did during pregnancy. They may be part of a genetic syndrome, but more often are simply "sporadic," meaning they are not genetically inherited or passed on. 

How Are Port-Wine Stains Diagnosed?

Doctors can sometimes tell if it's a port-wine stain by looking at a child's skin. Port-wine stains usually are nothing more than a harmless birthmark and don't cause problems or pain. Rarely, though, they're a sign of other medical conditions.

For example, doctors will monitor port-wine stains on or near the eye or on the forehead. That's because they may be linked to a rare neurological disorder called Sturge-Weber syndrome that causes problems like seizures, developmental delays, and learning disabilities. Stains on the eyelids may also lead to glaucoma — increased pressure inside the eye that can affect vision and lead to blindness if it's not treated.

If there's a concern about the location of a port-wine stain or symptoms, doctors 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 another problem. If a child has a port wine stain anywhere on the body, it's important for a specialist to examine it to see what type it is and what kind of monitoring and treatment it needs, if any.

How Are Port-Wine Stains Treated?

Some port-wine stains are small and hard to see. But others can be 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 port-wine stains much lighter, especially when the birthmark is on the head or neck. Dermatologists or plastic surgeons usually give several treatments with a "pulsed-dye" laser. The laser targets the pigmentation in the stain and fades it. Multiple treatments can make the birthmark fade quite a lot.

Laser treatment often starts in infancy when the stain and the blood vessels are smaller and the birthmark is much easier to treat. But laser treatments also can help older kids and teens too. It's just that the longer someone has had the stain, the harder it might be to successfully treat it.

Laser treatment can be uncomfortable. Kids can usually get an anesthetic as a shot, spray, or ointment to numb the area. Young children and infants will get general anesthesia to help them sleep or relax during the procedure. These treatments are very brief, usually less than 10 minutes. After treatment, the area might be irritated and inflamed at first, similar to a bad sunburn. But it will be back to normal in 7–10 days. Multiple treatments, if needed or desired, can be done as often as every 6–8 weeks.

For port-wine stains that get 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. Usually, these aren't cause for concern, but they often bleed and may need to be removed.

In the past, some people chose other treatments, 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, laser treatments may make the pigmentation darker than normal, but this usually is just temporary.

Keep in mind that laser treatments may not get rid of the birthmark entirely (though some birthmarks disappear completely after treatment). Plus, over time the birthmark may come back and need to be retreated.

For a few kids, laser treatment might not work at all. Every child's port-wine stain is different, so how well the treatment works will be different for each child.

How Can Parents Help?

Port-wine stains can get very dry sometimes, so it's important to use a moisturizer on the affected skin. Call the doctor if your child's port-wine stain ever bleeds, hurts, itches, or gets infected. Like any injury where there is bleeding, clean the wound with soap and water and, using a gauze bandage, place firm pressure on the area until the bleeding stops. If the bleeding doesn't stop, call the doctor.

If your child's port-wine stain was treated with laser surgery, avoid rubbing or scratching the area. Gently clean it with lukewarm water and follow your doctor's instructions for care of the treated area. Usually, this means putting an antibiotic ointment on it for the first few days, followed by moisturizing.

What Else Should I Know?

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 feel rude. 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 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. Of course, it's still natural if kids want to minimize a birthmark. Besides laser treatments, special cover-up makeup can help hide the stain.

It helps kids emotionally to be around supportive family and friends who treat them like everyone else. Work with teachers and school staff to ensure your child has a supportive learning environment free from bullying.

Kids with port-wine stains (or any birthmark, really) need to know that they're no different from other kids. 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.

Social media can be a good way to connect with parents of other children who have port-wine stains. You can share treatment information and talk about ways to help kids embrace their difference. Ask the care team for recommendations. You also can look online at:

• The Vascular Birthmarks Foundation