Port‐Wine‐Stain–Associated Dermatitis: Implications for Cutaneous Vascular Laser Therapy

Abstract

Port-wine stains are congenital vascular malformations affecting 0.3% to 0.5% of infants. Dermatitis occurring exclusively or most severely within port-wine stains has been described in the literature. Traditionally, topical corticosteroid therapy has been used for the treatment of dermatitis, while pulseddye laser treatment is considered a safe and effective means of lightening the appearance of congenital port-wine stains. To describe the development of port-wine stain-associated dermatitis as well as a rational treatment approach to these patients, we studied three children with facial, limb, or truncal port-wine stains who developed dermatitis within the congenital vascular malformation either prior to or during treatment with pulseddye laser. Laser therapy of dermatitis-affected areas was subsequently deferred pending resolution of the dermatitis with topical corticosteroid or topical calcineurin inhibitor treatment. While pulseddye laser therapy is an effective means of lightening port-wine stains and achieving lasting resolution of any associated dermatitis, this therapy to dermatitis-affected areas should be postponed until the inflammation resolves to minimize the risk of laser-associated adverse effects.

Eczematous dermatitis in an infantile hemangioma with minimal or arrested growth

“…We hypothesize that the warmth from high vascularity may lead to bacterial and yeast overgrowth, which are known to exacerbate atopic dermatitis. The dermatitis of PWS has responded to topical steroids, but definitive treatment with pulsed dye laser usually results in complete clearance of the dermatitis without recurrence . Therefore, in patients with IH‐MAG with dermatitis, it is possible that treatment with systemic propranolol might have some role in promoting clearance of the dermatitis.…”

“…Simultaneous treatment of the overlying eczema did not appear to aggravate or delay the treatment response of the IH‐MAG. Although there are no reports of dermatitis within IH‐MAG, there have been multiple reports of dermatitis in PWS, positing that the vascularity results in a robust inflammatory response and high cytokine release in the area . Because IH‐MAG also has high vascularity, a similar mechanism could be at play.…”

Consensus Statement for the Management and Treatment of Port-Wine Birthmarks in Sturge-Weber Syndrome

“…Eczematous skin changes (eg, Meyerson phenomenon) have been observed within PWBs earlier in childhood, particularly in children with preexisting atopic dermatitis. 14 Key topic 2: The best timing for evaluation of a facial PWB is at birth.…”

The Pathogenesis of Port Wine Stain and Sturge Weber Syndrome: Complex Interactions between Genetic Alterations and Aberrant MAPK and PI3K Activation

“…PWS can also involve the oral cavity mucosa, gingiva, tongue, larynx, nose, neck soft tissue and even the parotid glad, resulting in complications such as macrocheilia, gingival bleeding, dysphonia, parotideal swelling, epistaxis, globus pharyngeus, dysphagia, upper airway obstruction [22,30]. Formation of pyogenic granulomas and the occurrence of eczematous dermatitis can also be observed within PWS [31,32]. The scaling, pruritic, excoriated, and inflammatory conditions associated with eczematous dermatitis can happen solely or most severely within the borders of the PWS [32].…”

“…Formation of pyogenic granulomas and the occurrence of eczematous dermatitis can also be observed within PWS [31,32]. The scaling, pruritic, excoriated, and inflammatory conditions associated with eczematous dermatitis can happen solely or most severely within the borders of the PWS [32].…”