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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. [ABSTRACT FROM AUTHOR]

A case study of a 76-year-old man presented to our clinic with thickened and tightened skin that worsened over the course of 1 year, as well as numerous scattered small, firm, flesh-colored papules arranged in a linear pattern different parts of skin. Topics include punch biopsy of the upper back performed at an outside institution revealed increased histiocytes; and Serum protein electrophoresis revealed the presence of a protein of restricted mobility on the gamma region.