History:

A 60-year-old woman has had unilateral nevus flammeus, port-wine stain variant, on the face since birth. With time, the red patches started to increase in thickness and depth of color becoming purplish to bluish- red thick plaques. At age of 30s, the patient noticed new outgrowths (warty excrescences) developed within the nevus; these growths were the source of bleeding induced by minor trauma from time to time. Two week before presentation, an inexperienced non-medical man advised an herbal cream (unknown nature?) to abolish these outgrowths resulted in relatively long lasted bouts of bleeding.  On examination, unilateral slightly elevated purplish plaques on the right half of the face are seen. Many vascular nodules, some are covered with hemorrhagic crusts and some are necrotized, are evident.  It is interesting to notice that the nevus respecting the midline of the face and the right side of the upper lip is swollen (involved by the vascular malformation). The patient was referred to laser therapeutic center for definitive treatment.