Delayed ulceration following combination pulse dye laser and topical sirolimus treatment for port wine birthmarks: A case series

Port wine birthmarks (PWB) are capillary vascular malformations within the papillary and reticular dermis, most commonly occurring on the head and neck and may darken and thicken with age. Pulsed dye laser (PDL) is the gold standard of treatment for PWB as it selectively targets involved vessels. Sirolimus is a macrolide antibiotic that selectively inhibits mammalian target of rapamycin, thereby suppressing the angiogenesis pathways that can be activated by PDL. Sirolimus and PDL may be used together to treat PWB. We present a case series describing three cases of delayed ulceration and systemic sirolimus absorption following combination therapy, highlighting a potential complication and patient safety concern.

Automated summary

Port wine birthmarks (PWB) are vascular malformations that can darken and thicken with age, commonly occurring on the head and neck. Pulsed dye laser (PDL) is the preferred treatment for PWB as it targets the affected blood vessels. Sirolimus, an antibiotic, can be used in combination with PDL to suppress angiogenesis pathways. However, there is a potential risk of delayed ulceration and systemic sirolimus absorption, which raises concerns about patient safety.