Editor's Note: Dr. Castellini is a guest author for AT columnist Shellie Goldstein.
The scientific name for port wine stain birthmark is Nevus flammeus. It is present at birth and appears as a smooth, flat, pink or red patch. With age, it becomes larger, thicker, and turns dark purple with multiple black spots called vascular blebs. In the United States, it is present in one of every 1,000 births.
Physiologically, Nevus flammeus is the result of abnormally formed dilated capillaries under the skin. There is no genetic component and no known genetic underlying issue, although it can be found in other family members. To date, laser is the only treatment available.
However, possible complications of laser treatment include increased disfigurement and deformity, emotional and social trauma, glaucoma in the affected eye (if the birthmark is on the face / near the eye, as in this case), and may be associated with Sturgeon-Weber syndrome.
The Case Study
Presentation: The patient is 60 years old, 5' tall and weighs 160 lbs. Upon her initial visit, she presented with a very large port wine stain encompassing her right cheek, right eye, and half of her upper lip and nose, also on the right side of her face. Her skin appeared greasy with large pores and multiple black marks throughout the stain. Initially, her primary concern for acupuncture treatment was her puffy eyes and drooping jawline.
History: Twenty years ago, she was diagnosed with fibromyalgia. She had bilateral carpal surgery and a ganglion cyst removed from her finger. She was prescribed medication for the fibromyalgia, but discontinued since she felt it was not helping. She is presently not taking any medication.
She continues to be plagued by musculoskeletal pain, but remains active with regular exercise and dance. She describes the social trauma of having only three friends through high school and the pain of having to wear very thick makeup to be in her brother's wedding.
Her father was a diabetic, had chronic stomach issues and a stroke later in life. There were five siblings; her brother had a port wine stain on his entire forearm and her sister had a large congenital nevus on the back of her leg.
Diagnosis / Treatment
This patient's tongue was purple around the edges and generally an overall purple tone. Her pulse was wiry. The diagnosis for this patient was liver qi stagnation with blood stasis.
Throughout a course of 10 treatments, her protocol consisted primarily of needling LV 2,3,4, LI 4, SP 6, 9,10, GB 34, 37, KI 3, 6, ST 36,39,44, and DU 20, plus multiple facial points including points in and around the port wine stain.
Facial gua sha with organic safflower oil, and nanoneedling with a TCM serum, was added. On the second and eighth treatment I also used microneedling with hyaluronic acid and the same TCM serum.
After her second and third treatments, she reported sharp pain over the right eye. On the fourth visit, we both noticed a change in the intensity of the color of the port wine stain, with a significant improvement in her skin texture. By her 10th visit, the port wine stain was noticeably smaller, some areas were of normal skin color, and the back marks had lessened or disappeared. Her eyes appeared less puffy and her jawline appeared tighter.
After completing her 10 treatments, she scheduled additional appointments.
Clinical Takeaway
These results were much more than anticipated. I am not sure if this treatment will be effective for everyone with port wine stain birthmarks, and should be evaluated on a case-by-case basis. For those who are uncertain about laser treatment, this TCM protocol can at least give patients options and hope.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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