Eczema in a port-wine stain

A 28‐year‐old woman had a congenital vascular malformation on the nape of her neck, the shoulder and arm on the left side. She was not atopic and had no eczematous or dry skin lesions elsewhere. She had had pruritic erythematous lesions on the congenital vascular malformation since 1976 which had gradually become more severe and prompted reassessment in 2001. At this time she had a macular, red lesion on the nape of the neck, the shoulder and arm on the left side. A diagnosis of port‐wine stain (PWS) was made. The pruritic erythematic scaly lesions were observed on the nape of the neck, the shoulder and arm on the left side and were confined within the PWS (Fig. 1a). Some of the pruritic erythematic scaly lesions formed annular configurations (Fig. 1b). KOH examination of the scales revealed no fungi; histology revealed spongiosis with hyperkeratosis and parakeratosis of the epidermis. Dilated capillaries of the upper‐middle dermis were the cause of the stain, and an infiltration of lymphocytes and eosinophils was observed around the dilated capillaries. The lymphocyte infiltrate involved the epidermis, and slight extravasation of erythrocytes was seen (Fig. 2). A diagnosis of eczematous change in a PWS was made on the basis of the clinical and histological findings. Following 2 weeks of treatment with topical steroid for the eczema, the pruritic scaly erythema had cleared and there was no recurrence until 7 months after treatment, at which time the eczema recurred on her arm. The patient then began treatment of the PWS with a pulsed dye laser; the PWS was successfully treated and the eczema did not recur.