Cutis marmorata telangiectatica congeita (CMTC)

  • It can be upsetting when your child is born with a birthmark. And after your child’s doctor diagnoses it as cutis marmorata telangiectatica congenita (CMTC), you’ll probably have some questions.

    It’s entirely natural that you might be concerned about your child’s health; seeing the purple birthmark of CMTC can be frightening. But the most important thing we can say to you right now is “don’t worry.”

    Here’s what you need to know about CMTC:

    • It’s a distinctive deep purple, net-like staining pattern that is present at birth.
    • CMTC is a mostly cosmetic problem that substantially improves over the course of your child’s first year.
    • Since it poses little health risk, it rarely needs to be treated at all (fewer than one percent of kids who have CMTC receive any treatment for it).

    How Children’s Hospital Boston approaches cutis marmorata telangiectatica congenita

    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 seen numerous kids with CMTC, so they understand more about this rare condition—which means that if your child needs treatment he will get the best care from the most experienced physicians.


    Cutis marmorata telangiectatica congenita: Reviewed by Marilyn Liang, MD,
    © Children’s Hospital Boston, 2010

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  • It can be hard to find accurate information about cutis marmorata telangiectatica congenita (CMTC) because it’s such a rare condition. Here at Children’s Hospital Boston, we understand the condition—both what it is and what it’s not—and we know when and how to treat it.

    The bottom line: It may seem scary at first, but CMTC usually gets better on its own—and your child should go on to live a normal, healthy life.  Read on to learn more about how our doctors diagnose CMTC and help you decide whether your child needs treatment for this rare condition.

    What causes cutis marmorata telangiectatica congenital?

    No one really knows what causes cutis marmorata telangiectatica congenita.

    How common is it?

    It’s very rare. Since the condition was named in 1970, only around 100 cases have been reported in the United States.

    When does it appear?

    If your baby has CMTC, it’s obvious at birth.

    Is my child’s birthmark painful?

    No. The only time it might be painful is if there’s any bleeding.

    Signs and symptoms

    What are the signs of CMTC?

    The only sign of CMTC is the birthmark itself.  It’s a deep purple, net-like staining pattern that usually appears on your child’s trunk or legs.

    Are there any symptoms of CMTC?

    Not usually—it’s primarily a cosmetic concern. Sometimes kids with CMTC are more affected by cold temperatures than other kids. The birthmark often becomes more prominent during cold weather.

    There are a few other rare symptoms:

    • ulceration (bleeding) of the areas of the skin where the birthmark appears
    • undergrowth of the limb where the birthmark appears can result in your child’s legs having different lengths, which could lead to trouble and/or pain with walking

    Don't worry too much, though: These symptoms occur in less than one percent of children with CMTC.

    Long-term outlook

    What is the long-term outlook for my child?

    CMTC typically goes away on its own. Your child may have some telangiectasias (small, dilated blood vessels) left after the birthmark has faded, but these can be treated with pulsed dye laser. Read more about laser therapy at Children’s.

    You may have heard that CMTC sometimes affects the growth of your child’s limb (usually the leg), causing one leg to grow faster or slower than the other. While this can be true, the good news is that it doesn’t affect very many kids with CMTC—and if your child does end up with a difference in the length of her legs, our expert orthopedists can help correct the problem.

    Can CMTC come back after it fades?

    No. Once your child’s birthmark fades, it’s gone for good. As we said earlier, there may be some residual telangiectasias or dilated veins, which can be treated with laser therapy.

    FAQ

    Q: What is cutis marmorata telangiectatica congenita (CMTC)?
    A:
    CMTC is a distinctive deep purple, net-like mark that is present on your baby’s skin at birth. It usually appears on the trunk and limbs.

    Q: Does it get better?
    A:
    It does. The birthmark will fade substantially over the first year of your child’s life as his skin strengthens and matures.

    Q: Are there any symptoms of CMTC?
    A:
    Not usually—it’s primarily a cosmetic concern. However, kids with CMTC are sometimes more affected by cold temperatures than other kids. The birthmark often becomes more prominent during cold weather.

    There are a few other rare symptoms:

    • ulceration (bleeding) of the areas of the skin where the birthmark appears
    • undergrowth of the limb where the birthmark appears
      • can result in your child’s legs being two different lengths, which could lead to trouble and/or pain with walking

    Don't worry too much, though: These symptoms occur in less than one percent of children with CMTC.

    Q: Is it painful?
    A:
    No. The only time the birthmark might be painful is if there’s any bleeding.

    Q: What is the long-term outlook for my child?
    A:
    CMTC typically gets better on its own. Your child may have some telangiectasias left after the birthmark has faded, but these can be treated with a pulsed dye laser. For more information about laser therapy, see the Treatment & Care section.

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

    Q: How is CMTC treated?
    A:
    Usually, we don’t treat CMTC at all. The purple, marble-like pattern fades on its own over the first year as your child’s skin matures and thickens. Your child’s doctor will probably recommend observation after making sure that no other abnormalities are present.

    Q: What are our options for cosmetic treatments?
    A:
    Having a birthmark can be psychologically or socially difficult, and you may decide that—after it’s faded—you’d like to treat your child’s CMTC with laser therapy.

    At Children’s, we use a device called a pulsed dye laser to destroy the telangiectasias that remain after the CMTC has faded. Pulsed dye laser is the gold standard of treatment for telangiectasias 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 at any other hospital.

  • Diagnosing cutis marmorata telangiectatica congenita (CMTC) can be difficult for primary care physicians simply because it’s such a rare condition. The specialists at the Vascular Anomalies Center, at Children’s Hospital Boston understand CMTC and can easily identify it—and determine whether your child needs treatment.

    How do I know if my child has CMTC?

    A physician experienced in diagnosing birthmarks can tell you whether your child has CMTC just by examining the affected area. If your child’s doctor suspects another condition might also be present, she may recommend an imaging study such as the following:

    • x-ray: An x-ray is usually the first procedure performed; it gives your child’s doctor information regarding the need for further testing.
    • magnetic resonance imaging (MRI): This high-resolution scan allows the doctor to detect any related abnormality in your child’s muscles, nerves, bones and blood vessels.

    When should I consult a vascular anomalies specialist?

    We advise consulting a vascular anomalies specialist in a few situations:

    • if your child’s birthmark seems to be growing
    • if your child has any pain or bleeding from the birthmark
    • if your child’s birthmark appears on her face

    If your child has CMTC in conjunction with knee, hip or leg pain, this can be a sign that her legs are growing at different rates. While she may not require treatment for this, it’s important to keep an eye on the condition.

  • At Boston Children's Hospital, we consider you and your child integral parts of the care team and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.

    Undoubtedly, you were distressed when your child was diagnosed with cutis marmorata telangiectatica congenita (CMTC). That's understandable—every parent wants their child to be healthy. But we can't emphasize enough that most of the time CMTC won't cause any other problems for your child.

    The purple, marble-like pattern fades on its own over the first year as your child's skin matures and thickens. Your child's doctor will probably recommend observation after making sure that no other abnormalities are present.

    What are our options for cosmetic treatments?

    Having a birthmark can be psychologically or socially difficult, and you may decide that  after it's faded, you'd like to treat your child's CMTC with laser therapy.

    At Children's, we use a device called a pulsed dye laser to destroy the abnormal blood vessels (telangiectasias) that remain after the CMTC has faded. Pulsed dye laser is the gold standard of treatment for telangiectasias 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. It should only take one or two treatments to destroy the blood vessels and lighten your child's skin.

    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 10 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. Sunburn and suntan may absorb the laser light and make the treatment less effective.

    • You should also avoid sun exposure 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.

    Should your child develop any of the complications related to CMTC, we'll refer him to the appropriate specialists to design a treatment plan.

    Follow-up 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 ensure that the CMTC is not affecting the growth of your child's limbs.

    While there are no lasting effects of CMTC, as your child gets older, he may be uncomfortable with the skin lesion, especially if it's in a prominent location such as on the face or neck. Our counselors can help your child deal with the psychological and social issues related to having a birthmark.

    Coping and support

    We understand that you may have a lot of questions when your child is diagnosed with CMTC.

    • Will it go away?
    • Is it a sign of anything else?
    • How will it affect my child long term?
    • What kinds of treatment are there?
    • What do we do next?

    We've tried to provide some answers to those questions in the following pages, but there are also a number of other resources to help you and your family.

    Parent to parent: Want to talk with someone whose child has been treated for CMTC? We can often put you in touch with other families who can share with you their experience at Children's.

    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—What symptoms might my child have? What do we do next? They will also reach out to you by phone, continuing the care and support you received while at Children's.
     
    Faith-based support: If you are in need of spiritual support, we will help connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.

    Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.

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

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

    And here are a few helpful links to pages with more information about CMTC:

  • 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.

    The 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 CMTC and other vascular anomalies. Learn more about our research.


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