Port Wine Stain or Capillary Malformation
Introduction
Capillary malformations are permanent pink-red or purple flat birthmarks that can occur on any part of a baby's body (e.g. scalp, face, neck, arms and legs). They are present from birth and tend to grow proportionally as your child grows and often become darker over time.
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Red vascular birthmark of capillary malformation or port wine stain on face of baby
Who gets it?
Capillary malformations occur in about 3 in 1000 infants with boys and girls being affected equally. These usually present at birth but may become more obvious with time. They tend to persist throughout life.
What causes it?
Capillary malformations are caused by tiny blood vessels called capillaries being enlarged allowing blood to collect in them. This leads to a maroon discolouration to the skin which can be described as 'port wine stain'.
In most cases, are no underlying genetic problems and children with these birthmarks will be healthy and well. In rare instances, there may be some genetic syndromes that are associated with the birthmark.
What does it look and feel like?
Looks like…
Well-defined flat pink, purple or red areas
Mostly occurs on one side of the body (85%) or sometimes on both sides
Grows proportionately as your child grows
Spots can darken and thicken with age
Can be small or large lesions
Feels like…
They feel smooth and flat when your child is an infant.
The skin can then thicken and become bumpier (cobblestone appearance) as your child grows.
What tests might be needed?
Usually no tests are required to diagnose capillary malformations. However, very large capillary malformations on the forehead, scalp or eye may signal internal involvement. When this happens there may be unusual blood vessels on the brain which can lead to changes to blood flow to the brain. In these situations imaging studies such as MRI may be ordered to look at the brain and surrounding tissue.
If the capillary malformation is around the eye, your child may require a referral to an ophthalmologist (eye specialist) to test for pressure and vision problems in the affected eye. A neurologist may also be involved to manage children that have a small risk of developing epilepsy.
If the capillary malformation affects the arms or legs then testing to measure the limb length and bone growth as well as referral to an orthopaedic doctor (bone specialist) may be necessary.
What treatments are available?
What can I do?
Avoid knocking or bumping the birthmark as this can cause bleeding.
Apply a moisturiser regularly.
Monitor the lump in case it ulcerates or bleeds.
Medical Therapies
Capillary malformations usually do not cause any problems for an infant and are barely noticeable especially when they occur in areas other than the face. However, because they can become darker, and may grow and thicken over time, they can make your child feel embarrassed or self-conscious about their skin.
Types of treatment can include
Laser therapy - Pulsed dye lasers help lighten the birthmark and usually several courses of treatment are required to achieve adequate results. If opting for laser therapy, it is best if treatment starts before 2 years of age as port-wine stains will respond better during this period.
Cosmetic camouflage- Covering up with make-up can be helpful. Speak to your child's dermatologist about brands that are able to achieve good colour match and give great coverage.
What happens after treatment?
Most children will need between 6 to 10 laser therapy sessions, each being 4 to 8 weeks apart. These aim to lighten the stain and are successful in 50-80% of children. Some birthmarks are more responsive to treatment than others. Following laser treatment, the skin may bruise or be more sensitive so it is important to protect the skin by applying sunscreen to the area and to follow the after care instructions given by the dermatologist.
What support is available?
Your GP and dermatologist will help guide you and your child with treatment. It is important to be referred early to specialists, especially if the capillary malformation is on the head, to determine if other structures like the eye and brain are affected.
Support is availble for children and families who are affected by this condition at Vascular Birthmark Foundation https://birthmark.org/
Authors/Reviewers:
Author: Dr Beverly Manago
Paediatric Reviewer: Dr Mayuri Sivagnanam
Editor in Chief: Dr Tevi Wain
