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Portwine stain
birthmarks
Exceptional healthcare, personally delivered
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Welcome to North Bristol NHS Trust
At North Bristol NHS Trust we provide
hospital and community healthcare to the
residents of Bristol, South Gloucestershire
and North Somerset, plus a specialist
regional centre for neurosciences, plastics
and burns, orthopaedics and renal services.
Across our hospitals in Southmead and Frenchay, and our local
community work through school nurses, health visitors and
therapists, the delivery of exceptional patient healthcare is at
the heart of our Trust.
Already 92% of our patients are happy with the care they receive
from us and every year 6,000 patients and carers make the time
to write us a letter thanking us for the care they received.
Exceptional care
As the largest hospital teaching Trust in the South West we
have internationally renowned teams delivering incredible
outcomes for our patients through the hard work and
dedication of our 9,000 doctors, nurses, healthcare
professionals and support staff.
For many years we have been at the forefront of new medical
innovations, including brain and spinal surgery, joint
replacement and the world’s first radar breast imaging system.
We provide award-winning services and receive a significant
number of referrals from other hospitals for our range of specialist
services. We treat over 250,000 patients a year, including the
delivery of 5,800 babies, and yet each patient is treated with
respect and dignity and, most important of all, as a person.
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Personal care
We want to make sure that during your stay with us you feel
welcome, relaxed and confident in the care you are receiving. All
our teams care about the quality of the service provided to you,
from the moment you walk through the door until you leave
Protecting your privacy and dignity all inpatient beds are in single
sex areas and we have instigated protected visiting hours to
ensure you get your full rest and recuperation.
Safe care
Patient and visitor safety is at the forefront of delivering
exceptional healthcare, not only the focus on safe medical
procedures, cleanliness and infection control but also personal
safety whilst visiting us.
We are recognised for our excellent patient safety and we
gained a ‘5 star’ rating by Dr Foster’s, the UK’s leading
independent provider of healthcare information. This rating
means we are the safest hospital Trust in the South West and
one of the top 10% hospital Trusts for patient safety in England.
Patient safety also extends into how we hold your personal data.
Our new Medical Records and Data Centre ensure your details
are kept within state-of-the-art security with all records such as
treatment notes, x-rays and prescriptions all kept in one place.
Efficient care
By providing efficient healthcare we will further reduce
waiting times, you will be treated swiftly during your stay and
we’ll build seamless links with your GP and community social
service teams.
All-in-all at North Bristol NHS Trust we believe in providing you
with exceptional healthcare, that’s personally delivered.
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Welcome to the Laser Centre of the South West
We are part of the Plastic Surgery Department at Frenchay
Hospital and were set up in 1992 as one of the first UK centres
to offer skin laser treatments.
We treat patients from all over the South West area, both private
and NHS referrals. All our staff are fully trained doctors and nurses
who have received specialist training in skin laser treatment. A
variety of lasers are available for different skin conditions and
we are able to treat babies and children, as well as adults.
We also provide non-laser treatment via our camouflage clinic
and Outlook clinic offering emotional support and
counselling services.
What is a portwine stain?
A portwine stain is a birthmark that may look pink, red or
purple in colour. It is made up of many layers of blood vessels,
which are larger than they should be, and near to the surface
of the skin. It is the blood flowing through these blood vessels
that causes the colour.
The birthmark can occur anywhere on the body, it can be any
size and it will grow in proportion as the body grows. Over time
a portwine stain may darken, thicken, and/or develop small
surface lumps.
What has caused it?
The cause is unknown. It is not inherited from either parent,
nor is it caused by anything related to the mother in pregnancy.
No parent should feel responsible for these birthmarks. It
occurs in an estimated three children per thousand births.
What is laser therapy?
The laser is a very powerful energy source that produces a very
bright light. By controlling the colour, energy and direction of
the laser it is possible to heat the blood in the vessels. This
damages them and causes them to shut down.
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How successful is treatment?
Most portwine stains fade with laser treatment, but they are
rarely completely removed. Some portwine stains also reduce in
size with treatment.
Occasionally these marks do not respond at all to laser treatment.
In some people the fading is only temporary and the colour may
return in time. Further treatment may then be required.
What are the possible side effects?
The risk of side effects is low. The treatment can occasionally
cause the normal pigment in the skin to decrease or increase.
This means a pale or dark mark where the treatment has been.
This usually returns to normal but can take a long time to do
so. Very rarely a scar can occur in the treated area. Side effects
are more common if the skin is tanned when treated, so you
should wear sun block on the area before treatment begins and
during the course of treatment.
Which laser will be used?
We have three lasers that can be used for fading portwine
stains. The first treatment usually consists of several test
patches, at different powers, with one or more of the lasers. At
your next appointment we will decide which laser and power
suited you best.
What does the laser feel like?
It depends on which laser is used for treatment. The pulse dye
lasers feel like a rubber band being snapped at your skin. Most
people find it uncomfortable but not painful. The KTP laser
feels like hot pin pricks.
What pain relief is available?
Many people find they do not need any pain relief. Various
skin cooling devices can be used to reduce discomfort. Local
anaesthetic injections or creams are available if needed. Young
children usually need a general anaesthetic as a day case.
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Who will treat me?
At your first appointment the specialist doctor will assess you
and discuss treatment. This will give you a chance to consider
all the factors involved. You may have a test treatment on the
same day. Only experienced doctors and laser nurse specialists
who have received specialist training will treat you.
How can I prepare for treatment?
It is very important that your skin is as pale as possible
before treatment. You should not have a suntan or use
sun beds, false tan or 'holiday skin' moisturisers.
You must protect the area from the sun before and during the
course of treatment by using sunblock or keeping the area
covered. If your skin is dry, use a plain moisturiser over the area.
If the stain is in a very hairy area, you may be asked to shave
your skin.
Some medication and herbal remedies make your
skin more sensitive to lasers. Please bring a list of your
medicines to your assessment and tell us each time your
medication changes.
What happens after treatment?
The pulse dye lasers leave purple bruises over the treated area,
which last for up to fourteen days. With any laser treatment
your skin may feel hot and sore, but this does not last long. You
may get some swelling over the treated area, and it may itch.
Little aftercare is necessary. You will be given written instructions
on how to care for the treated area.
How many treatments will I require?
It depends on the size and position of the birthmark. Most
portwine stains require at least 10 treatments for maximum fading.
Treatments are spaced at least 8 weeks apart. Unless the area is
very large the whole area can be treated at every appointment.
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Are photographs necessary?
We require photographs of the area to be treated before
you start a course of treatment and at intervals during your
treatment. This helps us to monitor your progress and any side
effects of treatment. You can request a photographer of the
same sex as yourself if you wish.
Do I have to have treatment?
No. Only you will know if fading your birthmark will be of benefit
to you.
How can I make an appointment?
The Laser Centre offers both an NHS and private service. For
NHS patients a referral letter from your GP or hospital consultant
is required before an appointment can be arranged. A referral
letter may not be necessary for private treatment. Some
treatments are only available privately. Staff at the centre can
give you further details. See back cover for contact details.
Other support
Sometimes people find these marks distressing, and other
people’s reactions can be difficult to deal with. We can put you
in touch with organisations that can help. Frenchay Hospital
also offers a service called 'Outlook', which offers counselling
to adults and children.
You may wish to consider using camouflage cover as well as, or
instead of, laser treatment. A camouflage make up service is
available at Frenchay Hospital.
Reference
Lanigan, S. 2004. Recent advances in laser treatment of portwine
stains. British Journal of Dermatology. Sep: 151(3) 527-33.
NHS Constitution. Information on your rights and responsibilities.
Available at www.nhs.uk/aboutnhs/constitution
[Last Accessed March 2010]
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How to contact us:
H
Laser Centre of the South West
North Bristol NHS Trust
Frenchay Hospital, Frenchay
Bristol BS16 1LE
0117 340 3807
0117 340 3980
www.nbt.nhs.uk
If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.
© North Bristol NHS Trust. First Published November 2002. This third edition published May 2010. NBT002016