What are vascular malformations?
They are classified according to the type of vessels and blood flow speed. Slow malformations - capillary, venous and lymphatic - are more common and are usually not dangerous to the circulation. Rapid ones involving arteries are rare and require the supervision of a vascular surgeon. Separately, there is a simple nevus, which is popularly called a stork bite: pink spots on the back of the head, bridge of the nose and eyelids, turning pale in the first years of life. It is important to understand that malformations exist from birth and grow with the child, and infant hemangioma is a vascular tumor that appears after birth and then decreases on its own.
- Capillary malformation - port-wine stain
- Venous malformation - soft bluish formation
- Lymphatic malformation - bubble collections
- Arteriovenous malformation - rapid blood flow, rare
- Simple nevus “stork bite” - fades over time
- Hemangioma is not a malformation, but a vascular tumor
How is a port wine stain different from a hemangioma?
This difference determines all further tactics. The port-wine stain is noticeable already in the maternity hospital, it is flat, turns pale when pressed, the boundaries are clear, the size increases only in proportion to the growth of the child. Infantile hemangioma is often absent or barely noticeable at birth, grows rapidly in the first weeks, rises above the skin, and then fades and shrinks over the course of several years. If necessary, hemangiomas are treated with drugs of a certain group under the supervision of a physician, and capillary malformation is treated with a laser; these approaches are not interchangeable.
- Malformation is visible from birth, hemangioma appears later
- The malformation is flat, the hemangioma protrudes above the skin
- Hemangioma grows, then regresses on its own
- The wine stain does not disappear and darkens over time.
- Treatment is fundamentally different
When is an examination needed?
Most port-wine stains on the trunk and extremities are not accompanied by other disorders. The location on the face in the area of the forehead, upper eyelid and temple causes caution: with this option there is a risk of combination with changes in the blood vessels of the meninges and eyes. In this case, the child undergoes an MRI of the brain and is regularly examined by an ophthalmologist with intraocular pressure measured, since glaucoma can develop at any age. Extensive spots on the limb require control of the length and volume of the arm or leg, as asymmetry of growth is possible.
- A spot in the forehead and upper eyelid - examination is required
- MRI of the brain with this arrangement
- Regular examination by an ophthalmologist and monitoring of pressure in the eye
- Observation by a neurologist, EEG for seizures
- Measuring the length and circumference of a limb for large spots
- Ultrasound of soft tissues to assess the depth of the lesion
Diagnostics
In most cases, the diagnosis is made during examination: the doctor evaluates the color, borders, behavior when pressing, the temperature of the skin over the formation and its change during crying or stress. Ultrasound of soft tissues with Doppler sonography shows the depth of the lesion and the speed of blood flow, helping to distinguish slow malformations from fast ones. MRI is needed for large, deep formations and for facial localization. A biopsy is usually not required. If a syndromic form is suspected, the child is referred to a geneticist and specialized specialists for a comprehensive assessment.
- Examination by a dermatologist and pediatrician
- Dermatoscopy
- Ultrasound of soft tissues with Dopplerography
- MRI of the brain and soft tissues
- Examination by an ophthalmologist
- Genetic consultation for syndromic forms
Treatment and care
The standard treatment for capillary malformation is pulsed dye laser. It selectively affects blood vessels without damaging the surrounding skin, and is carried out in a course of several procedures at intervals. The earlier treatment is started, the better the result: in young children the spot is thinner and lighter. It is not always possible to completely remove color, but significant lightening is achievable for most. Creams, ointments and folk remedies do not work. For everyday life, it is important to protect the skin from the sun and, if desired, special corrective camouflage products that are safe for children's skin.
- Pulsed dye laser courses
- Early treatment gives better results
- Repeated courses are possible in adolescence
- Skin protection from ultraviolet radiation
- Concealing cosmetics if desired
- Observation by an ophthalmologist and neurologist for facial localization
- Psychological support for the child and family