Capillary Malformations

Capillary malformations appear pink, red or purple due to an increased number and size (diameter) of affected blood vessels in comparison to normal capillaries of the skin. As your child grows, the affected blood vessels will continue to enlarge and thicken, causing the color of the lesion to darken. Over time, clusters of tiny, dilated venules (small vessels that collect blood from the capillary junctions and join to form veins) may give a lumpy appearance to the skin. The degree and length of time to develop skin thickening varies greatly among individuals, and may be delayed into early or mid-adulthood.

Most capillary malformations are diagnosed by history and physical exam alone. A full physical exam that looks for thickening, asymmetry or warmth is also helpful in eliminating similar or related diagnoses.

Capillary malformations can be associated with overgrowth of underlying soft tissues or bones. The color of a facial lesion can darken, and the skin can thicken with age and may be prone to bleeding.

When the capillary malformation involves the forehead and/or upper eyelid, abnormalities of the eye and/or brain may be present (Sturge-Weber syndrome). All lesions around the eye should have routine eye exams to evaluate for glaucoma. Magnetic resonance imaging (MRI) may be used to determine if there is brain involvement.

Capillary malformations in the skin directly overlying the spine can be associated with spinal abnormalities such as tethering of the spinal cord and should be investigated with an ultrasound or MRI.

Several treatment approaches are used to treat capillary malformations.

Laser therapy with the pulsed-dye laser is the standard treatment for capillary malformations on the face. The goals of treatment are both to prevent lesions from thickening and to allow children to maintain an appearance that is cosmetically acceptable. Many lesions lighten significantly after multiple treatments, but very few resolve completely. Laser therapy may also prevent the skin from thickening over time. The outcome with laser is better in the facial area than on the trunk or limbs. Since the laser does not penetrate deeply, deeper vessels do not respond as well as vessels nearer the skin surface. The number of treatments required varies significantly (depending on the size and depth of the lesion). Treatments are usually spaced at two- to three-month intervals. Because the procedure is typically painful, either a general or a topical anesthetic is used. General anesthesia is preferred in children, but the frequency of procedures is limited due to sedation risks.

Surgical procedures may be considered when there is overgrowth of soft tissue or bone enlargement. In cases where the skin is very thick and laser therapy is unsuccessful, surgery and skin grafting may be performed.

While each of these treatment approaches can be effective, they both involve certain risks.

The risks of treatment with pulsed-dye laser are low if treatment is performed by an experienced clinician. Rarely, blistering may occur, resulting in scarring. Pigment changes, either whitening or temporary darkening of the skin, may also occur with variable risk depending on skin color. Even with laser treatment, a capillary malformation may reappear after several years.

The risks of surgery depend upon the type of surgery performed and the complexity of the problems in each individual patient. However, general risks include infection, minor bleeding and scarring. A risk of skin grafting is the loss of the graft.

Even with laser treatment, a capillary malformation may reappear after several years. The goals of treatment are thus to both prevent lesions from thickening and to allow children to maintain an appearance that is cosmetically acceptable.