title: Confocal microscopy study of nerves and blood vessels in untreated and treated port wine stains: preliminary observations.
abstract: 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.
authors.affiliation: Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Mona M
authors.initials: MM
authors.lastname: Selim
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Kelly
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Nelson
authors.forename: Gwen
authors.initials: G
authors.lastname: Wendelschafer-Crabb
authors.forename: William R
authors.initials: WR
authors.lastname: Kennedy
authors.forename: Brian D
authors.initials: BD
authors.lastname: Zelickson
mesh_terms: 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*