Vascular anomalies are birthmarks and growths made of blood vessels. Some fade on their own. A port-wine stain is present at birth and remains on the skin for life without treatment. These are evaluated and treated at Coastal Dermatology + Aesthetics in San Luis Obispo.
Two categories that behave in opposite ways
“Vascular anomaly” covers birthmarks and growths made of blood vessels, and the classification used for them splits into two groups that behave in opposite ways. [11] Vascular tumors grow and then involute, which is an infantile hemangioma, which grows and then fades. Vascular malformations are present at birth and do not involute. [11] A port-wine stain is a capillary malformation, and that is the category it belongs to. [11]
A port-wine stain, medically a nevus flammeus, is visible at birth as a flat spot or patch that can be pink, red or purple. [1] It usually develops on the face, though it can appear anywhere on the skin. [1] [7] It is the most common vascular malformation, it is present at birth, and it persists throughout life. [7]
As the child grows, so does the birthmark, and its texture changes. It tends to thicken and darken over time. Ridges can develop, and sometimes the surface comes to feel like cobblestones. [1] Progressive thickening and nodularity are part of the natural course. [7] Port-wine stains do not go away without treatment. [5] Without treatment, this birthmark remains on the skin for life. [1]
Some vascular malformations run deeper than the skin, including arteriovenous malformations and combined and syndromic forms. Superficial ones are treated here. Where an anomaly needs a multidisciplinary vascular anomalies program, that referral is part of what an evaluation produces.
When treatment for a port-wine stain is associated with the best outcomes. Starting in infancy, particularly in the first year of life, produces greater lightening and can head off later thickening. [8]
Where vascular birthmarks come from
The vessels form differently
A vascular malformation is a difference in how blood vessels formed, present from birth. [11] In a port-wine stain the capillaries in an area of skin are wider than usual, which is what produces the color. Nothing a parent did during pregnancy causes one.
Why it darkens rather than fades
The vessels are a permanent structural feature rather than a growth phase, so there is nothing to involute. [7] [11] Over the years the affected vessels widen further, which is why a mark that started flat and pink can become darker, raised and uneven in texture. [1] [7]
Where the face matters
A port-wine stain across the upper face, particularly around the eye or forehead on one side, is the pattern associated with the rare syndrome described further down this page, [9] and it is the reason a facial port-wine stain is worth a proper look early rather than a cosmetic conversation later.
Babies born with a port-wine stain. [5] Uncommon enough that most families have never met another one, common enough that a dermatology practice sees them regularly.
What laser treatment actually achieves
This section publishes the real numbers, because the alternative is a page that implies these clear completely and a family who finds out otherwise on session six.
| Question | The honest answer |
|---|---|
| What is the treatment | In the United States the pulsed dye laser is the standard for all port-wine birthmarks, whatever the size, location or color [8] |
| How many sessions | Most patients need 8 to 10 treatments or more, and touch-up treatments are frequently needed even after a successful series [8] |
| What that achieves | Pulsed dye laser can achieve 50% to 90% clearance, and most patients will have more than 50% lightening [8] |
| Whether it clears completely | More than 50% improvement is seen in most cases, and complete clearance may not be [7] |
| How often | Sessions run at intervals of roughly 1 to 3 months [7] |
| Does age matter | Treatment at an earlier age, particularly in the first year of life, is associated with better outcomes [8] |
| Is it safe for children | Pulsed dye lasers are safely used on infants and children, including for port-wine stains [3] |
Read the third and fourth rows together. Substantial lightening is a realistic goal for most port-wine stains, over a course measured in years rather than visits, and complete clearance is not what the evidence describes. [7] [8] Anyone promising erasure is describing something the published results do not support.
The timing argument is the strongest one on this page. A port-wine stain does not fade, it grows with the child, and it thickens and darkens over time. [1] [5] [7] Greater lightening, and possible prevention of future darkening and thickening, are associated with starting treatment at an earlier age. [8] Early treatment tends to be more effective. [2]
This is also true for adults, and it is worth saying. Progressive thickening and nodularity make an older port-wine stain harder to treat, [7] and it is still treatable. The session count runs longer and the improvement is real.
Which red birthmark is it?
| What you are seeing | How it behaves | What it is |
|---|---|---|
| Flat pink or salmon patch, often on the eyelids, forehead or back of the neck, irregularly shaped with feathery or undefined edges, that fades when gently pressed and brightens when the baby cries or gets warm [1] [6] | On the face it tends to disappear between 1 and 3 years of age. On the back of the neck it may fade without disappearing [1] | A salmon patch, called an angel’s kiss on the face and a stork’s bite on the neck [1] |
| Flat pink, red or purple patch present at birth, usually on the face | Grows with the child, thickens and darkens, and remains for life without treatment [1] [7] | A port-wine stain, a capillary malformation [1] [11] |
| Raised strawberry-colored lump that appeared in the first weeks and is getting bigger | Grows for a few months, then shrinks over years [see Infantile Hemangiomas] | An infantile hemangioma, a vascular tumor [11] |
The distinguishing test parents can do at home is gentle pressure. A salmon patch tends to lighten temporarily under a fingertip and has feathery, undefined edges. [1] [6] A port-wine stain is present at birth and persists. [7] That is a useful observation to bring to an appointment, and it is not a substitute for one, because the appointment is where the answer gets made.
Crissa is a wonderful addition to the practice, can’t wait to return.
The Coastal difference
The right laser for this, in San Luis Obispo
In the United States the pulsed dye laser is the standard treatment for port-wine birthmarks, whatever the size, location or color. [8] The pulsed dye laser here is a Candela Vbeam®, and its FDA clearance names the indication in plain terms: treatment of cutaneous capillary malformations, also known as port wine stains, in the pediatric population, alongside infantile and congenital hemangiomas. [10] That is the device sitting in this building, cleared for exactly this use. Pulsed dye lasers are safely used on infants and children. [3]
The nearest alternatives for a Central Coast family are the university children’s hospitals. Those programs are excellent, they are the right answer for a complex or syndromic anomaly, and they are several hours away in either direction. For a superficial vascular birthmark, the useful thing is a board-certified dermatologist within driving distance who can identify it, treat it on a schedule a family can actually keep, and refer onward when the situation calls for it.
The same device is used for broken surface vessels in adults and for persistent facial redness, which is why it is in the building at all. The pediatric vascular indication is the part of its capability that is least well known locally.
The pulsed dye laser here carries an FDA clearance naming port wine stains and infantile hemangiomas in children. [10] Devices are cleared rather than approved, and this one is cleared for this.
When to see a dermatologist
Book sooner if:
- A flat red or purple patch was present at birth and has stayed put
- The patch does not lighten when gently pressed
- It sits on the face, particularly across the forehead or around one eye [9]
- It has become darker, raised, ridged or uneven in texture [1] [7]
- An adult has carried one for years and wants to know what treatment would involve now
Most birthmarks are harmless, and having one examined is still worthwhile, because what looks like a birthmark can be the first sign of something else. [4] For a port-wine stain specifically, the reason to come early is that treatment starting in infancy is associated with better outcomes. [8]
What to know alongside it
A rare association worth knowing about
- A port-wine stain on the face, usually on one side around the eye or forehead, is occasionally linked to a rare condition called Sturge-Weber syndrome, which involves the small blood vessels of the brain, eyes and skin as well [9]
- The great majority of facial port-wine stains are not associated with it. Where the pattern raises the question, the evaluation is straightforward: an eye examination, and imaging such as an MRI or CT scan if a doctor suspects it [9]
- Where Sturge-Weber is confirmed, yearly monitoring for glaucoma is the standing recommendation, because raised pressure inside the eye is treatable and is worth catching early [9]
- Seizures are part of the condition and usually begin in infancy, and that care is led by a neurologist [9]
- This is on the page because a facial port-wine stain is the visible sign that prompts the question. It is not on the page to suggest that a birthmark means a syndrome
Day to day
- Sun protection over the area is sensible practice and does not change what the birthmark does
- Camouflage makeup is a legitimate option at any age and is not a lesser choice than treatment
- Treatment runs as a course, with sessions at intervals of roughly 1 to 3 months [7]
- Bring photographs taken in consistent light. Change across a long course is easier to see in a series than in a mirror
Worth knowing
- Port-wine stains are present at birth and persist throughout life [7]
- They do not go away without treatment [5]
- They tend to thicken and darken over time [1] [7]
- Treatment starting at an earlier age is associated with better outcomes [8]
- Substantial lightening is a realistic goal. Complete clearance may not be [7] [8]
Treatments we offer
Evaluation, laser treatment for superficial vascular birthmarks and vessels, and onward referral where an anomaly runs deeper. Pick a treatment to see how it works.
What treatment costs
Evaluation and treatment of a vascular birthmark are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book.
Treatment for a port-wine stain runs as a course rather than a single visit, and our office will set out how that is structured before anything is scheduled.
The two categories
Vascular tumors, which grow and then shrink, and vascular malformations, which are present at birth and stay [11]
What a port-wine stain does over time
Grows with the child, and tends to thicken and darken [1] [7]
How common a port-wine stain is
About 3 of every 1,000 babies [5]
When treatment works best
Earlier. Treatment starting in infancy, particularly in the first year of life, is associated with better outcomes [8]
Vascular anomalies frequently asked questions
The clearance pulsed dye laser can achieve on a port-wine stain, with most patients seeing more than 50% lightening across a course of 8 to 10 treatments or more. [8] Published figures, so you can plan against them.
Offered at
Want to know what a birthmark is? Request an appointment
Fill out the form below, book online in Santa Maria (opens online scheduler), or give us a call. Cosmetic and aesthetic appointments need no referral. For medical dermatology, we are accepting new patients by referral from your primary care physician; send the referral across and then use the same form.
Sources and medical review
1. American Academy of Dermatology Association. “Birthmarks: Signs and symptoms.” On the port-wine stain, medical name nevus flammeus, states that “at birth, you’ll see a spot(s) or patch(es) that can be pink, red, or purple,” that “as the child grows, so will this birthmark,” that in time it “tends to thicken and darken, and as it thickens, the texture can change. Ridges may develop, and sometimes the birthmark feels like cobblestones on the skin,” that “a port-wine stain usually develops on the face; however, it can appear anywhere on the skin,” and that “without treatment, this birthmark remains on the skin for life.” On the salmon patch, medical name nevus simplex, states that “you’ll see a flat, pink, red, or salmon-colored spot or patch,” that “if you gently press on this birthmark, the color tends to fade,” that the color becomes more noticeable when a baby cries or becomes overheated, that “when a salmon patch appears on the face, it’s often referred to as an angel’s kiss,” that “on the back of the neck, people often call this birthmark a stork’s bite,” and that “on the face, this birthmark tends to disappear between 1 and 3 years of age.” https://www.aad.org/public/diseases/a-z/birthmarks-symptoms · Medical Organization
2. American Academy of Dermatology Association. “Birthmarks: Diagnosis and treatment.” States of the port-wine stain: “This birthmark will not go away with time. It can grow and thicken. Early treatment tends to be more effective.” Lists port-wine stains among “birthmarks that don’t fade with time,” alongside café au lait spots and moles, and states: “Have a dermatologist examine a birthmark as soon as you notice it, so you know what type of birthmark your child has and whether it needs treatment.” https://www.aad.org/public/diseases/a-z/birthmarks-treatment · Medical Organization
3. American Academy of Dermatology Association. “Skin conditions lasers treat.” States that “some lasers, such as pulsed dye lasers and intense pulsed light therapy, are safely used on infants and children to treat a wide range of conditions, including port wine stain and hemangioma birthmarks.” https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat · Medical Organization
4. American Academy of Dermatology Association. “Birthmarks: Overview.” States that “one thing that most birthmarks have in common is that they’re harmless. Yet, if you see a birthmark on your child’s skin, it’s wise to have a dermatologist examine it,” and that “what you think is a birthmark could be the first sign of a skin disease.” https://www.aad.org/public/diseases/a-z/birthmarks-overview · Medical Organization
5. Cleveland Clinic. “Port Wine Stain.” States that “about 3 of every 1,000 babies have a port wine stain,” that “a port wine stain is a permanent birthmark that usually appears on the face,” that “over time, port wine stains usually get darker and thicker. They also may become raised rather than flat and smooth,” that “port wine stains don’t go away without treatment,” and that “the most common treatment is laser therapy to shrink the blood vessels and fade the birthmark.” Notes that port wine stains rarely occur in people with Klippel-Trenaunay syndrome or Sturge-Weber syndrome. https://my.clevelandclinic.org/health/diseases/24389-port-wine-stain · Medical Organization
6. Cleveland Clinic. “Stork Bite (Nevus Simplex).” Describes the appearance as irregularly shaped, with feathery or undefined borders, and states that these marks “might get lighter temporarily when you put pressure on them, like if you press your finger against one, then let go.” https://my.clevelandclinic.org/health/diseases/21975-stork-bite · Medical Organization
7. StatPearls, National Center for Biotechnology Information. “Nevus Flammeus.” States that “PWS is the most common vascular malformation, typically presenting as pink or red homogenous, variably sized macules and patches with geographic borders at birth that persist throughout life,” and that “it is a congenital skin condition that can affect any part of the body and persists throughout life.” States that “a 585-nm short pulsed dye laser (PDL) is considered the gold standard in treating PWS,” that “multiple treatment sessions may be required at intervals of 1 to 3 months,” that “although more than 50% improvement will be seen in the majority, a complete clearance of the lesion may not be seen,” that “treatment initiation as early as infancy is found to have consistent improvement, better outcomes, and decreased risk of cutaneous hypertrophy and disfigurement,” and that “laser therapy at an early age gives better results as the progressive thickening and nodularity seen with age make it recalcitrant to treatment.” https://www.ncbi.nlm.nih.gov/books/NBK563254/ · Medical Reference
8. Sabeti S, Ball KL, Burkhart C, Eichenfield L, Fernandez Faith E, Frieden IJ, Geronemus R, Gupta D, Krakowski AC, Levy ML, Metry D, Nelson JS, Tollefson MM, Kelly KM. “Consensus Statement for the Management and Treatment of Port-Wine Birthmarks in Sturge-Weber Syndrome.” *JAMA Dermatology.* 2021;157(1):98–104. PMID 33175124. A multi-institutional United States expert consensus statement. States that “in the US, pulsed dye laser is the standard for all PWBs regardless of the lesion size, location, or color,” that “pulsed dye laser has the longest history of efficacy and safety for treatment of PWBs, and many studies support this device as the standard,” that “pulsed dye laser can achieve 50% to 90% clearance, and most patients will have more than 50% lightening,” that “most patients require 8 to 10 treatments or more for optimal results; however, touch-up treatments are frequently needed even after an initial successful series of lightening,” that “based on expert observations and limited studies, treatment of PWBs at an earlier age, particularly in the first year of life, results in better outcomes,” and that “greater rates of lightening and possible prevention of future darkening and hypertrophy may be attained if treatments are started at an earlier age.” https://jamanetwork.com/journals/jamadermatology/fullarticle/2772814 · Scholarly Article
9. National Institute of Neurological Disorders and Stroke, National Institutes of Health. “Sturge-Weber Syndrome.” Describes it as “a rare neurological condition characterized by abnormal development of the small blood vessels (called capillaries) in the brain, eyes, and skin.” States that it involves “a port-wine stain birthmark, which is usually present at birth on one side of the face around the eye or forehead,” that it can involve “glaucoma (increased pressure within the eye), which can cause the eyeball to enlarge (buphthalmos). This usually starts in infancy and can cause blindness if not treated,” that “people with Sturge-Weber syndrome should be monitored yearly for glaucoma,” that “seizures usually begin in infancy and may get worse with age,” that “most infants with SWS will develop seizures during their first year of life,” that “if the doctor suspects SWS, they will use imaging tests, such as an MRI… or CT… scan,” and that “laser treatment may lighten or remove the birthmark.” https://www.ninds.nih.gov/health-information/disorders/sturge-weber-syndrome · Government Organization
10. U.S. Food and Drug Administration. 510(k) Premarket Notification K230990, “Candela Vbeam Family of Pulsed Dye Lasers (Vbeam Prima, Vbeam Perfecta),” Candela Corporation, decision date June 1, 2023, product code GEX, regulation 878.4810, Class 2, found substantially equivalent. The cleared indications include, at 595 nm, a pediatric population indication for “treatment of cutaneous capillary malformations, also known as port wine stains (PWS), and infantile hemangiomas (IH) / congenital hemangiomas.” https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf · Government Organization
11. International Society for the Study of Vascular Anomalies. “ISSVA Classification of Vascular Anomalies (2018).” Divides vascular anomalies into two top-level categories, vascular tumors and vascular malformations. Classifies “infantile hemangioma / hemangioma of infancy” as a benign vascular tumor, and classifies “cutaneous and/or mucosal CM (also known as ‘port-wine’ stain)” as a simple capillary malformation, with nonsyndromic and syndromic subtypes. https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf · Medical Organization
Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Vascular anomalies vary widely and the descriptions here are general rather than specific to any individual. Laser treatment of a port-wine stain is a course of treatment with variable results, and the published figures cited describe averages and expert consensus rather than any individual outcome. Laser treatment carries risks including changes in skin color, blistering and scarring, which are discussed before treatment. FDA clearance of a device describes the uses for which the device may be marketed and is not a statement about any individual outcome. Deeper and syndromic vascular anomalies are managed by multidisciplinary programs, and referral is part of what an evaluation produces. Individual results may vary.