From the real experts at Hassenfield Children’s Hospital at NYU Langone:
Last time, we learned about the most common type of vascular birthmark in babies, the infantile hemangioma. Read on to learn more about the other most common vascular birthmark in babies, capillary malformations.
Capillary malformations are another very common vascular birthmark. More commonly called “port wine stains,” “angel’s kiss,” or “salmon spots,” they are the result of dilated capillary connections close to the surface of the skin. Unlike infantile hemangiomas, these vascular birthmarks are almost always clearly visible at birth. They start off pink, red, or salmon-colored, flat and flush with the skin, and usually stay flat for years. They are painless and do not bleed, and they do not follow their own growth cycle like infantile hemangiomas do. Depending on the type, they either fade early on, or grow with the patient and remain present for life.
When capillary malformations are located along the middle of a baby’s body, they are called medial capillary malformations. On the face, they appear in the middle of the forehead, and point downwards in a V shape that ends with the point of the V around the tip of the nose. The sides of the V can cross the skin of the eyelids. On the back of the neck, they spread from the bottom of the hairline to the upper neck. They can also be located at the base of the spine. While common, medial capillary malformations usually fade on their own by two to three years of age, and generally do not require treatment.
Capillary malformations that are closer to the sides of the body are less likely to disappear without treatment. If these more lateral birthmarks are left alone, they can continue to darken and begin to grow thicker. They tend to turn a rich purple color, and will go from flat and smooth, to raised, with areas that feel like nodules under the skin. When they get to this point, they become much more difficult to treat.
Which Capillary Malformations Need Treatment?
In general, if a capillary malformation appears to be growing or darkening, it should be evaluated by a specialist. This is not only because there can be cosmetic consequences to leaving it alone, but also because, similar to infantile hemangiomas, capillary malformations can be external signs of internal issues. If this is the case, your doctor may order an MRI to check your baby’s internal organs. In particular, the brain and eyes may need to be examined if there are extensive capillary malformations over the face.
In very rare cases, a capillary malformation birthmark can also be an early sign of more serious health issues that are not obvious until late childhood. Because of this, babies with capillary malformations that are not in the middle of the body and/or do not fade after birth should be followed by a vascular anomalies specialist.
Laser therapy is the mainstay of treatment for capillary malformations. If laser therapy is chosen for your baby, the treatments will be spaced out to allow time for healing in between sessions. Your doctor might also prescribe a cream that helps to shrink the blood vessels close to the skin’s surface, which helps to make the effects of laser treatment longer lasting. This cream is also available without laser therapy, but is more effective when combined.
Take Home Message for Parents
All in all, most vascular birthmarks are completely benign, and will not lead to any complications or necessitate any treatment. If any of your baby’s marks resemble what has been described here, and you have more questions, speak with your pediatrician about seeing a vascular anomalies specialist. And congratulations on your new baby!
Megan M. Gaffey, MD, is a pediatric otolaryngologist at Hassenfeld Children’s Hospital at NYU Langone. She specializes in the medical and surgical treatment of children with complex ENT issues. She has focused training in vascular malformation management.