[Reprint from the St. Louis Courier of Medicine, March, 1886.1 
NOTE ON THE TREATMENT OF PORT-WINE MARK 
ELECTROLYSIS. 
By W. A. Hardaway, A. M., M. D., Professor of Diseases of the Skin 
in the St. Louis Post-Graduate School of Medicine and in the Missouri 
Medical College. 
[Read before the American Dermatological Association, Greenwich, Conn 
Aug. 27, 1885.] 
SOME of the members present will recall the discussion on 
the treatment of port-wine mark which occurred at the Third 
Annual Meeting of this Association at New York in Aug., 1879. 
On that occasion I claimed to have tried electrolysis in that de- 
formity using a bundle of needles with great benefit. Others 
had either never employed it, or had been disappointed in its 
use. 
In Piffard’s Materia Medica and Therapeutics of the Skin (1881), 
the author records having treated two small wine marks with fairly 
good results by this method. He employed a Carroll’s vacci- 
nator. Later, in the Archives of Medicine, Dr. Gr. H. Fox called 
general attention to this mode of procedure. In the St. Louis 
Courier or Medicine, June, 1883,* I made this statement: 
“I have not seen a case in which some degree of improvement 
has not been manifest, and in some port-wine marks of small ex- 
tent the results have been brilliant. ’n Lastly, Dr. Fox in his il- 
lustrated work on Diseases of the Skin (1885) thus sums up his 
experience in this operation: “The electrolytic treatment of 
wine mark I have practised during the last five years, and, al- 
1. This operation is not to be confounded with the similar one, that is 
by electrolysis, first proposed by me for the obliteration of enlarged ves- 
sels in rosacea and allied states. See Arch of Dermatology, Oct., 1879.” 2 
though I cannot claim that the operation accomplishes all that 
could be desired, I have repeatedly succeeded in transforming a 
dark and unsightly stain into a smooth patch of a light pink hue. 
The object aimed at in the treatment of wine-mark by electroly- 
sis, as in the case of scarification and puncture, is to excite suffi- 
cient inflammation to destroy the fine net work of blood-vessels. 
As the galvanic current is more active, and at the same time 
more manageable than acid adhering to the points of needles; it 
is not strange that this method should produce the desired effect 
in the speediest manner and with the least injury to the surface 
of the skin.” So far as I know the references and quotations 
above constitute the literature of the subject. 
Now at the end of six years of experience in the electrolytic 
treatment, I think I may be justified in laying before you the 
results of my observations. 
The modus operand! is, of course, well understood, and con- 
sists in the use of a needle or needles, placed in a suitable 
holder, which latter is attached to the negative pole of a galvanic 
battery. The successive steps of the operation are the same as 
those that I have often described in connection with the removal 
of superfluous hairs. The most important point relating to any 
destructive operation upon the skin, is that the operator should 
control the destroying agent as much as possible. The facility 
with which this end is accomplished in electrolytic methods con- 
stitutes one of its chiefest merits. In order, therefore, that I 
may control this destruction in the most satisfactory way, I have 
for a long time discarded the bundle of needles, and make the 
electrolytic puncture with one only. 
By the cautious and expert use of this one needle, I now no 
longer set up extensive areas of suppuration, as was apt to be 
the case with the crown of needles; and since employing the 
single needle I have no fear of the keloidal scars, which some- 
times followed the introduction of the bundle. The operation is 
thereby rendered somewhat more tedious, but certainly safer. 
It is a tedious thing to do at best, for when the puncture is made 
the surrounding region becomes so blanched, that we are at 
something of a loss to know exactly where to make the next one 
to the best advantage, and the next day for quite a space around 3 
the operated place there is an inflammatory areola, and perhaps 
crusting, which forces us to wait for a number of days before 
operating again. Then I have found that one cannot really form 
an estimate of the result in a given area until at least six weeks 
or two months afterward; and when I have gone over all the 
space that I intend working upon, I am in the habit of dismissing 
the patient for a season. No one pretends for a moment that in 
a port wine-mark of any magnitude this operation is going to 
leave a normal skin behind it. In the majority of cases we aim 
to produce minute multiform scars, which in time become white, 
and thus obliterate the nevus. 
It often happens, however, that a large area is permanently 
blanched without scar by apparent obliteration of vessels at its 
periphery. In some cases I have observed that intense brown 
pigmentation takes the place of the red surface, which, however, 
gradually undergoes absorption, leaving the skin white. This 
generally occurs on parts where the the skin is thin. Where 
one needle is employed the resulting scars are usually thin, 
supple, non-depressed, in no case leaving behind elevated knots 
and cords such as I have seen result from galvano-cautery. 
It is very important, as stated above, to allow periods of 
some weeks to intervene between the successive operations, so 
as to give ample opportunity to the skin for recuperation, and 
to enable one to see clearly the result. Even after a tolerably 
thorough first going over, it will be found that many pale spots 
and spaces have been established, and we then proceed to pick 
out the intervening red places. 
Proceeding in this necessarily cautious and deliberate way, 
many months may be occupied in the labor before any adequate 
result has been obtained; yet I know that the benefit conferred 
by this operation has made life worth the living to a good many 
people. 
Very often I think it is better, in a cosmetic way, to en- 
deavor merely to lighten the color of the mark rather than to 
convert it into a dead white patch; of course, where the mark is 
quite small, a thin white, and even glistening, cicatrix is not es- 
pecially objectionable. It is not uncommon to find that in an 
apparently obliterated wine-stain alter a while dot-like te- 4 
langiectases will appear here and there. They must be again de- 
stroyed. 
I do not know that I can better illustrate the features of the 
operation than to present the notes of three cases that have been 
under my observation for some time past. 
Case I. This patient, a fair haired young lady, had a port- 
wine stain of the left side of the face, taking in the brow, the 
upper eyelid, the left side of the nose, and the same side of the 
upper lip. She had been operated on by the various methods 
in vogue, namely, Squire’s Sherwell’s, and the electro-cautery. 
She reported the first two as being of no use in her case, or per- 
haps it would be better to say of no value as performed by the 
gentlemen she consulted. The electro-cautery operation had 
certainly been successful in the way of obliterating the stain in 
certain places, but the result was worse than the preceding 
deformity. On the forehead there resulted an elevated, radiat- 
ing scar, which was exceedingly disfiguring. The patient told 
me, moreover, that an ugly suppurating wound had followed 
the operation, which was weeks in healing. I commenced 
operating with a single needle on the side of the nose, the upper 
lip, and an isolated silver dollar-sized patch upon the temple. 
Later on I attacked the forehead and upper eyelid. 
Without going into the details of the tedious operations, 
which have run over a period of a year and a half, I shall speak 
merely of the effect so far produced. The patch on the lip is a 
great deal lighter, even in the places where the stain still persists, 
but in many places are to be seen small white scars. One place, 
near the ala of the nose, is perfectly blanched, although it was 
never operated upon. The discoloration on the nose is nearly 
gone, although here and there red dots are to be observed, suffi- 
ciently numerous, I must admit, to give this region still a pinkish 
hue although not at all as pronounced as the original color. The 
patch on the temple is absolutely obliterated, leaving in its place 
a white superficial scar. Over the forehead the red color has 
disappeared in many places, but in other parts a yellowish pig- 
mentation has supervened which is gradually, but surely, being 
absorbed; I attacked the. elevated cicatrix produced by the 
galvano-cautery, and, as I had observed before in other hy- 5 
pertrophied scars, the effect has been striking as regards smooth- 
ing down the scar. 
Taking it all in all, the condition of affairs in this case has been 
bettered at least fifty per cent, and I believe that I shall yet see 
this very much improved. 
Case 11. This was a dark-skinned young man, who had a tri- 
angular mark extending, as regards its base, from one angle of 
the eye to the other, and running to an apex at the junction of 
the nose and lip. When he first came to me five years ago I 
made a little operation on a small outlying portion about the 
size of a dime. I then advised him to wait several months to see 
how matters would turn out. He did not return to me for eight 
months for further work, but he was induced to come back by 
the fact that the operation had been successful. From this time 
on he would come into the city about every six months and stay 
two months at a time. The result has been very gratifying. The 
patch is but little visible, whereas formerly the young man had a 
most forbidding aspect. I have noticed that even on the most com- 
pletely worked over places now and then a little pin-head sized 
red spot will appear, which I again destroy. There has been 
nothing like an attempt at a general return, however; A letter 
which I have received from this patient will give a good idea of 
his estimate of the results, and in such cases, the patient is as 
well qualified to judge as any one else. Under date of July 25, 
1885; he writes as follows: “Everybody agrees that the work 
so far has been a success. The lower part and on the nose is al- 
most clear, but immediately under the eye, where it used to 
swell so, it is a little red yet, but not a dark red as at first. I 
am well satisfied that if the mark had been a little distance from 
the eye that it would have been gone by this time.” 
Case 111.—This was a red haired young man, with a deep red 
stain on the right side of the nose. I worked on him for six 
months, but the result has been miserable, A few out-lying 
spots have been made to disappear, but the mass of the stain is 
in about the same condition as before. At one time while work, 
ing around the periphery of the patch the central part became 
nearly white, but in a few weeks the color returned ot about the 
same tone as before. Even the spots where the needle had been 6 
plunged, producing a great deal of inflammation and crusting, 
do not seem to become white scars, as is usual, but become red 
again, even when a pit has resulted. The affected tissue seems 
to be unusually spongy, and must be exceedingly vascular.1 
I have tried to make a fair presentation of the facts as I have 
observed them, and my object has been, not so much to vaunt a 
particular operation as infallibly successful, as to bring out ex- 
perience on a very important matter. I must say in conclusion 
that, so far as I know, the electrolytic method offers a number 
of advantages, and, in the hands of a person experienced in its 
employment, secures results in many instances that are very 
gratifying to the patients at least. lam far from saying that 
other methods are not equally satisfactory because I have not 
succeeded with them; for I believe that an operation which 
from lack of skill may prove unsuccessful in my hands, may be 
very efficient when done by one especially skilled in its per 
formance. 
2303 Olive Street.