Confocal microscopy study of nerves and blood vessels in untreated and treated port wine stains: preliminary observations.
OBJECTIVE
Vascular ectasia in port wine stain birthmarks (PWS) might result from reduced innervation with loss of autonomic stimulation. We investigated this theory and evaluated nerve and blood vessel density, and mean blood vessel size in untreated and treated PWS skin.


METHODS
Skin biopsy specimens were obtained from uninvolved skin, untreated PWS, PWS with a good response to laser treatment and PWS with a poor response to laser treatment. Confocal microscopy was performed to determine nerve and blood vessel density, and mean blood vessel size.


RESULTS
Nerve density was significantly decreased in all PWS sites compared to uninvolved skin. Mean blood vessel diameter was larger in untreated compared to treated PWS. PWS with a good response to treatment had decreased nerve density but blood vessel density and mean diameter was relatively normal. PWS with a poor response to treatment had decreased nerve density but increased blood vessel density and mean blood vessel diameter compared to normal skin.


CONCLUSIONS
Nerve density was decreased in all evaluated PWS sites and this may be a factor in lesion pathogenesis. PWS blood vessel size correlated with pulsed dye laser response and may prove to be a useful prognostic indicator of therapeutic outcome.
Selim
Mona M
MM
Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.
Kelly
Kristen M
KM
Nelson
J Stuart
JS
Wendelschafer-Crabb
Gwen
G
Kennedy
William R
WR
Zelickson
Brian D
BD
D000328:Adult; D001132:Arm; D002196:Capillaries / Q000473:pathology / Q000528:radiation effects; D002610:Cheek; D006801:Humans; D028022:Low-Level Light Therapy; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology / Q000528:radiation effects; D019339:Port-Wine Stain / Q000503:physiopathology* / Q000532:radiotherapy*; D012039:Regional Blood Flow; D012867:Skin / Q000098:blood supply / Q000294:innervation / Q000528:radiation effects*