Dawaa Reference

chronic

Port-wine stain

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class SD55.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Sturge-Weber Syndrome - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK459163/ · Nevus Flammeus - StatPearls - NCBI Bookshelf - disease-level clinical article (port-wine-stain-full.txt)

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Nevus Flammeus - StatPearls - NCBI Bookshelf - disease-level clinical article (port-wine-stain-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • The mark does not hurt, does not bleed by itself, and feels no warmer than surrounding skin
  • It enlarges in step with the growth of the child
  • Over the years it deepens in colour, turning purplish
  • In Sturge-Weber, fits often start by two years old, sometimes with opposite-sided neurological deficit and learning difficulty [learning difficulty · seizures]

Signs — what you find (12)

  • Pink or red uniform macules and patches of varying size with map-like edges, present from birth and lifelong
  • Skin of the head and neck is involved in 70% to 90% of cases; trunk or limbs are possible and mucosa rarely
  • On the face it is usually segmental, following the trigeminal nerve territory
  • Facial lesions thicken and hypertrophy in later life, with or without nodules, as dermal vessels progressively dilate
  • Overgrowth of the fat, muscle and bone beneath is rare and mostly seen with facial lesions
  • A stain over the midline lumbosacral region may be a skin marker of hidden spinal dysraphism
  • Forehead involvement, taking in upper eyelid and midline frontonasal skin, is the single strongest predictor of Sturge-Weber
  • Highest CNS risk comes with widespread bilateral disease, hemifacial forehead involvement, or a midline stain over more than half of one forehead side
  • Limb overgrowth alongside a combined capillary, lymphatic and venous malformation suggests Klippel-Trenaunay syndrome
  • Multiple scattered stains with a pale halo, plus arteriovenous malformation, point to the RASA1 capillary malformation-arteriovenous malformation syndrome [pallor]
  • An acquired form, Fegeler syndrome, follows trauma and also drugs such as isotretinoin, the pill, simvastatin and metformin, plus frostbite and herpes zoster
  • A choroidal angioma in Sturge-Weber can bring on glaucoma, buphthalmos or retinal detachment

Tests (6)

  • Diagnosis rests on the clinical appearance; assess a facial lesion at birth
  • Colour Doppler ultrasound gauges flow resistance and picks out fast-flow arteriovenous malformations that mimic it
  • CT, MRI and MR angiography map superficial or deep tissue anomalies in combined malformations or a syndrome
  • Image the spine when a stain sits with another skin marker such as a hair tuft, haemangioma, lipoma, dermoid cyst or tail-like appendage
  • Brain imaging in Sturge-Weber can show cerebral atrophy with gyriform calcification
  • Biopsy is not routine, but serves to rule out mimics, prove an acquired lesion, and provide tissue for genetic study

If not this — what else fits (8)

  • Salmon patch
  • Early haemangioma
  • Arteriovenous malformation
  • Tufted angioma
  • Eccrine angiomatous hamartoma
  • Cutis marmorata telangiectatica congenita
  • Segmental infantile haemangioma, which calls for a PHACES workup
  • Nevus simplex

SourceStatPearls "Nevus Flammeus" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

A congenital vascular birthmark; primary care's role is recognition, reassurance, and referral to dermatology/laser clinic for cosmetic treatment, plus screening for associated syndromes if periorbital. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A congenital vascular birthmark; primary care's role is recognition, reassurance, and referral to dermatology/laser clinic for cosmetic treatment, plus screening for associated syndromes if periorbital.

Cautions
  • A port-wine stain in the trigeminal (upper facial) distribution raises concern for Sturge-Weber syndrome - refer for neurological and ophthalmological assessment.
  • Rare in Egyptian primary care.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Glaucoma risk specifically named for periocular/eyelid PWS (app says only 'screening for associated syndromes if periorbital', without naming glaucoma)
  • RED FLAG - Regular follow-up is required for high-risk cases (eyelid involvement, combined vascular malformations, syndromic PWS).
  • A port-wine stain involving any part of the forehead, the upper eyelid, or the midline frontonasal area is the strongest indicator of Sturge-Weber syndrome - refer on forehead involvement even when the stain does not follow a classic trigeminal pattern.
  • Children with Sturge-Weber syndrome often develop seizures by the age of 2 years, which may be accompanied by contralateral neurological deficits and learning difficulties - warn parents what to watch for.
  • A port-wine stain over the midline lumbosacral area can be a cutaneous marker of occult spinal dysraphism.
  • Imaging is indicated when a port-wine stain is accompanied by another cutaneous marker such as a tuft of hair, a haemangioma, a lipoma, a dermoid cyst, or a true or pseudo tail.
  • A solitary nodule arising on a port-wine stain in adulthood may be a pyogenic granuloma, which is often ulcerated and bleeds after trivial trauma.
  • Refer for laser treatment early: starting in infancy gives more consistent improvement, better outcomes, and a lower risk of later skin thickening and disfigurement.
  • Where the stain involves mucosa, gingival hyperplasia can develop and predispose to periodontal disease and poor dental hygiene - arrange dental review.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.