Characterisation and treatment of patients with port wine stains with special reference to the emotional impact

Abstract: This thesis covers 12 years of experience in treating patients with congenital capillary malformations, so called port wine stains (PWS). The wide variation in treatment response to laser therapy has developed a profound need for the development of objective devises to measure treatment outcome, so that the maximum effectiveness of therapy can be achieved without unnecessary treatments. The purpose has been to better characterise PWS with the emphasis on blood flow, erythema, depth, so that the results of the treatment can be better (if possible) predicted, followed, documented and improved. We found that laser doppler imaging (LDI-a new technique) in the measurement of blood flow in PWS was more useful in research settings than as a predictive tool. Reflectance spectrophotometry has been superior to LDI in the prediction of the outcome of PWS therapy. It is objective and correlates well with clinical results and is also portable and easy to use. Skin ultrasound can help to characterise the PWS in the majority of patients and may help to predict the outcome of PDL treatment. With the help of special questionnaires, developed in collaboration with a child and adolescent psychiatrist, we have investigated the psychological and psychosocial impact a PWS can have on the individual according to the individual themselves or their family members. There is a high risk of developing negative parameters e.g. low self- esteem, school problems and difficulties in social relationships if you have a PWS, but the majority of these negative parameters can improve after the treatments.