Pigment meets vascularity: dermoscopic patterns of port-wine stains in fitzpatrick skin type IV and V – insights from a tertiary care center in Eastern India

Farheen Begum, Department of Dermatology, Venereology and Leprosy, KIMS Hospital, Bhubaneswar, Odisha, India Chinmoy Raj, Department of Dermatology, Venereology and Leprosy, KIMS Hospital, Bhubaneswar, Odisha, India Debasmita Behera, Department of Dermatology, Venereology and Leprosy, KIMS Hospital, Bhubaneswar, Odisha, India Priyanshi Tyagi, Department of Dermatology, Venereology and Leprosy, KIMS Hospital, Bhubaneswar, Odisha, India

Objectives: Port-wine stain (PWS) or nevus flammeus, a benign congenital capillary malformation characterized by an erythematous macule to plaque that often darkens and hypertrophies over time. While dermoscopy has emerged as a non-invasive modality for assessing vascular morphology in dermatology, limited data exist to describe dermoscopic features of PWS in Indian patients with Fitzpatrick skin types IV and V and explore morphological correlations with age. Methods: Seventeen patients with PWS aged between 6 and 34 years were enrolled in the study. Each patient underwent dermoscopic evaluation, and vascular morphology was noted. Results: Majority of the patients had lesions over the head-and-neck region (76.47%). Dermoscopy revealed dots and clots to be the most common finding present in 100% of the cases, followed by linear vessels in 94.11% and sausage vessels in 23.52%. Reticulate hyperpigmentation (88.23%) and white veil (41.17%) were the most common non-vascular features. Conclusion: This study demonstrates the utility of dermoscopy in identifying vascular morphologies of PWS in Indian patients. The predominance of dots and globules in the younger age group and the emergence of linear or mixed vessels in older patients align with findings by Huang et al. and Ngoc et al. Despite the study’s limitations of lacking histological confirmation, these findings contribute novel insights into PWS evaluation in darker skin types.

Keywords: Port-wine stain. Dermoscopy. Fitzpatrick skin type. Dots and globules. Mixed vessels.