ommended that caregivers change a child often and make frequent trips to the toilet. swim diapers or pants are not a substitute for frequent diaper changing. • Caregivers should wash child thoroughly (especially the anal area) with soap and water before swimming. Invisible amounts of fecal matter in the anal area can end up in the pool. (see also
SWIMMING AND DISEASE.)
port-wine stains A permanent purple-red birthmark that is present at birth and is usually found on the face. The birthmarks are usually sharply outlined and flat, although the surface may sometimes have a pebbly feel. They can range in size from a few millimeters to half the body's surface. They increase in size proportionately as the child grows, becoming darker over time. Port-wine stains may appear alone or as part of a multisystem disorder such as sturge-weber syndrome, which also features seizures and eye abnormalities.
Recent research suggests that the blood vessels in port-wine stains have an abnormal nerve supply, which may account for their enlargement over time.
A simple port-wine stain, when it does not occur as part of another syndrome, is still more than a cosmetic problem.
The most successful method of laser treatment is the pulsed dye device, which is popular because it has a low risk of scarring and its effectiveness is not dependent on the doctor's experience. Total clearing with pulsed dye laser treatment is uncommon, but dramatic lightening after a series of treatments is not unusual. Pulsed dye laser treatment decreases the solid color mass, thins thickened lesions, and lightens all types of port-wine stains. By treating patients early in their lives, the psychological burden is eased, the risk of darkening and thickening is reduced, and the risk of bleeding and infection during treatment is eliminated. over the past 10 years, the pulsed dye laser has been modified several times to lengthen the wavelength and the pulse duration, two changes that have enhanced results significantly.
Until the late 1980s, the argon laser was the treatment of choice for these birthmarks. The laser works by emitting light that is absorbed by the hemoglobin in the dilated blood vessels that make up the birthmark. However, this therapy is limited because of its substantial risk of scarring (the continually delivered laser energy dissipates into the surrounding skin, causing thermal damage). Less-than-optimum treatment can result in pale, immature port-wine stains. In addition, the extent of clearing and the rate of scarring is highly dependent on the skill and experience of the doctor.
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