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Capillary malformation

  • When you saw that your baby had a birthmark, you may have been concerned. But rest assured that birthmarks are very common in infants—and most of them are pretty harmless. A capillary malformation—sometimes called a "port-wine stain"—is a flat, red-pink stain on your child's skin that is present at birth.

    • It’s caused by dilated capillaries in the skin that enlarge and darken as your child grows older.
    • It’s mostly a cosmetic problem that often doesn’t need any treatment at all.
    • If it doesn’t go away, and is in a prominent location, you may want to consider laser therapy for your child.

    If your doctor told you that your child’s birthmark was called a capillary malformation, you probably have many questions:

    • What is a capillary malformation?
    • Will it go away?
    • How is it treated?
    • What does it mean for my child?

    At Children’s Hospital Boston, we’ve got answers for you.

    How Children’s Hospital Boston approaches capillary malformations

    Should we need to treat your child, you’re in the right place. Children’s is home to the world’s largest and most experienced Vascular Anomalies Center.

    When doctors anywhere in the world have questions about a child’s birthmark and how to treat it, they often call us.

    Our doctors have helped many kids with capillary malformations—which means that if your child needs treatment he will be cared for by some of the world’s most experienced physicians.

  • There are many different kinds of birthmarks. Some need treatment and some don’t. The most important thing to realize is that a birthmark does not define your child; it’s just another distinguishing characteristic, like the color of his eyes.

    And you really don’t need to worry too much about your child’s capillary malformation. Many kids with these kind of birthmarks don’t get any treatment at all, and here at Children’s, we understand the condition—both what it is and what it’s not—and we know when and how to treat it if you decide that’s the way you’d like to go.

    What is a capillary malformation?

    A capillary malformation—sometimes called a "port-wine stain"—is a flat, red-pink stain on your child's skin that is present at birth.

    • It’s caused by dilated capillaries in the skin that enlarge and darken as your child grows older.
    • It’s mostly a cosmetic problem that often doesn’t need any treatment at all.
    • If it doesn’t go away, and is in a prominent location, you may want to consider laser therapy for your child.

    How common are capillary malformations?

    They’re uncommon but not rare. About one in every 330 babies is born with a capillary malformation.

    When do they appear?

    If your baby has a capillary malformation, it’s present at birth, though it may not always be obvious depending on its location.

    Where can they appear?

    While they’re most commonly found on the head, face or neck, your child can have a capillary malformation anywhere on his body.

    He could also have several capillary malformations in different places on his body.

    Causes

    Capillaries are the smallest blood vessels in the body and researchers believe that these malformations occur while your child is still in the womb. A capillary malformation means that your child’s capillaries expand, which allows a greater amount of blood to flow through them—this is what causes the staining of the skin.

    No known food, medication or activity a mother did during pregnancy can cause her child to have a capillary malformation.

    Signs and symptoms

    The only sign of a capillary malformation is the birthmark itself. It’s a reddish-pink stain that usually appears on the face or neck, but can show up anywhere in your child’s body.

    A capillary malformation can darken in color and your child's skin can thicken as she ages. Tiny growths (called “blebs”) that bleed easily can appear from the birthmark.

    Long-term outlook

    There are very few long-term risks of capillary malformations. Despite the fact that the birthmark will grow as your child does, it typically doesn’t cause any serious health problems.

    If you decide to treat your child’s capillary malformation, we can help lighten the birthmark with pulsed dye laserRead more about how we treat capillary malformation with laser therapy.

    Will my child’s capillary malformation go away?

    No. A capillary malformation is a chronic condition, which means that it will grow with your child as he grows. That said, most kids with capillary malformations live normal, healthy lives.

    FAQ

    Q: What is a capillary malformation?
    A: 
    A capillary malformation—sometimes called a "port-wine stain"—is a flat, red-pink stain on your child's skin that is present at birth.

    • It’s caused by dilated capillaries in the skin that enlarge and darken as your child grows older.
    • It’s mostly a cosmetic problem that often doesn’t need any treatment at all.
    • If it doesn’t go away, and is in a prominent location, you may want to considerlaser therapy for your child.  

    Q: Are there any symptoms of capillary malformations?
    A: 
    The only sign of a capillary malformation is the birthmark itself. It’s a reddish-pink stain that usually appears on the face or neck, but can show up anywhere in your child’s body.

    A capillary malformation can darken in color and your child's skin can thicken as she ages. Tiny growths (called “blebs”) that bleed easily can appear from the birthmark.

    Q: Is it painful?
    A: 
    It can be. A capillary malformation might be painful if it develops growths called vascular blebs, which can bleed.

    A capillary malformation can also be painful if it’s covering a deeper vascular anomaly, as is the case in Klippel-Trenaunay syndrome.

    Q: Should my child see a vascular anomalies specialist?
    A:
     Rarely, a capillary malformation can be a sign of an underlying abnormality. We recommend consulting with a vascular anomalies specialist in a few situations:

    • A capillary malformation over the spinal column can sometimes be associated with spinal abnormalities.

    • A capillary malformation can cover a deeper vascular abnormality involving your child’s arteries, veins or the lymphatic system; in this case, your doctor will see excess growth in these tissues. For an example of this type of abnormality, read about Klippel-Trenaunay syndrome.

    • If the stain covers part of the forehead and upper eyelid, your baby should be evaluated for neurological problems. (Only eight percent of kids with a facial capillary malformation have neurological problems.)

    Q: What is the long-term outlook for my child?
    A: 
    There are very few long-term risks of capillary malformations. Despite the fact that the birthmark will grow as your child does, it typically doesn’t cause any serious health problems.

    If you decide to treat your child’s capillary malformation, we can help lighten the birthmark with pulsed dye laser. For more information about laser therapy, see our Treatment section.

    Q: Will my child’s capillary malformation go away?
    A: 
    No. A capillary malformation will grow as your child grows. That said, most kids with capillary malformations live normal, healthy lives.

    Q: How do I know if my child has a capillary malformation?
    A: 
    A physician experienced in diagnosing birthmarks can tell you whether your child has a capillary malformation just by examining the affected area.

    Q: What are our treatment options?
    A: 
    Having a birthmark can be psychologically or socially difficult, and you may decide that you’d like to treat your child’s capillary malformation with laser therapy.

    At Children’s Hospital Boston, we use a device called a pulsed dye laser to destroy the abnormal blood vessels in the capillary malformation. Pulsed dye laser is the gold standard of treatment for capillary malformations because it is highly effective and rarely causes any scarring.

    Q: What makes Children’s different?
    A: Our physicians are bright, compassionate and committed to focusing on the whole child, not just his condition—that’s one reason we’re frequently ranked as a top pediatric hospital in the United States.

    We’ve also got the world’s largest Vascular Anomalies Center, home to specialists who diagnose and treat more rare vascular conditions than any other hospital.

  • If your child has a birthmark anywhere on his body, you should have your pediatrician take a look at it. He or she can then refer you to a specialist, if appropriate.

    The specialists at the Vascular Anomalies Center at Children’s Hospital Boston can easily identify a capillary malformation—and then discuss what that diagnosis means for you and your child.

    How is a capillary malformation diagnosed?

    When you make an appointment at Children’s, we’ll start with a complete medical history and a thorough physical exam. In many cases, that initial exam gives us enough information to diagnose a capillary malformation.

    If your child’s doctor has any concerns that your child might have an underlying condition, she may recommend an imaging study such as a magnetic resonance imaging (MRI). This is a high-resolution scan that allows the doctor to detect any related abnormality in your child’s muscles, nerves, bones and blood vessels.

  • What are our options for cosmetic treatments?

    At Children’s, we use a device called a pulsed dye laser to destroy the abnormal blood vessels in the capillary malformation. Pulsed dye laser is the gold standard of treatment for capillary malformations because it is highly effective and rarely causes any scarring.

    How does it work?

    First, the doctor “tunes” the laser to a specific wavelength of light. It produces a bright light that is absorbed by blood vessels. The abnormal blood vessels are then destroyed without damaging the surrounding skin.

    What’s the treatment like?

    Your child’s physician holds a wand against the skin and "pulses" the laser for about a minute. During the treatment, your child wears eye protection because laser light can potentially harm the eyes.

    Is the treatment painful?

    Not really. The laser light feels a bit like a rubber band snapping against the skin. Afterwards, your child may feel a bit of pain equivalent to a minor sunburn.

    • If you’re worried about your child’s reaction to the discomfort, we can give her a topical anesthetic.
    • Tylenol can also help reduce the pain.

    Are there any side effects?

    There are a few minor side effects:

    • Immediately after the treatment, your child’s skin will be purple where the laser was focused. This lasts for seven to ten days.
    • As the purple fades, the treated area may still look red, but will slowly fade to normal skin color over the next few weeks.
    • In a few kids, crusting may develop in the first several days and last up to two weeks.
      Some kids may experience a temporary brown discoloration of the skin for several months.

    What else do we need to know about the treatment?

    • Avoid direct exposure to the sun for three weeks prior to the treatment. Sunburned and suntanned skin absorbs the laser light and make the treatment less effective.

    • You should also avoid situations where your child’s skin will be exposed to the sun for long periods of time (like at the beach) for several months after the treatment. We recommend always applying a sunscreen with SPF 15 or greater.

    • Avoid aspirin and aspirin-like products for 14 days prior to treatment.

    • You may want to apply antibiotic ointment and a bandage to your child’s skin immediately after treatment.

    What kind of results can we expect?

    Every kid is different and every capillary malformation responds differently to laser therapy. Laser therapy usually succeeds in lightening the stain, but doesn't make it go away completely.

    Are there any complications with pulsed dye laser therapy?

    Not really. But there are a few other things to keep in mind when considering laser therapy:

    • It can often take several treatments to lighten the birthmark.
    • Sometimes, the stain can come back after treatment.
    • In a very small number of kids, laser therapy doesn’t work at all.

    At what age should we begin treatment?

    We recommend starting treatment when your child is an infant. At this time, the stain is still small and so it’s much easier to treat.

    However, if your child is older, we can still treat her with the pulsed dye laser, though it may require more treatments to lighten her birthmark.

    In the rare case that your child has an underlying condition, we’ll refer him to the appropriate specialists to design a treatment plan.

    Coping & support

    We understand that you may have a lot of questions when your child is diagnosed with a capillary malformation. We’ve tried to provide some answers to those questions in these pages, and we have a number of other resources to help you and your family.

    Patient education: From the first office visit, our nurses will be on hand to walk you through your child’s treatment and help answer any questions you may have, such as: Does my child need treatment? What can we expect next? They will also reach out to you by phone, continuing the care and support you received while at Children’s.

    Parent to parent: Want to talk with someone whose child has undergone laser therapy? We can often put you in touch with other families who can share their experience at Children’s.

    Counseling: As your child gets older, he may be uncomfortable with his birthmark, especially if it’s in a prominent location such as on the face or neck. One of our counselors can help your child deal with the psychological and social issues related to having a birthmark.

    On our For Patients and Families site, you can read all you need to know about:

    • getting to Children’s
    • navigating the hospital experience
    • resources that are available for your family

    And here are a few helpful pages with more information about capillary malformations:

    • The Vascular Anomalies Center page has links to organizations that offer support and education for parents who have a child with a vascular anomaly.

    Long-term care

    A schedule of follow-up care will be determined by your child's physician and other members of your care team. The main purpose of these follow-up appointments will be to check on the effectiveness of the laser therapy and decide whether more treatments are necessary.

  • At Children’s Hospital Boston, we’re known for our science-driven approach. In fact, we’re home to the world's most extensive pediatric hospital research enterprise; and we partner with elite health care and biotech organizations around the globe. But as specialists in innovative, family-centered care, our physicians never forget that your child is precious, and not just a patient.

    Our Vascular Anomalies Center (VAC) conducts research that may lead to the development of new, more effective therapies and perhaps ultimately result in ways to prevent these anomalies. Read more about our research.

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