The commonest childhood growth is a haemangioma. This is different from some other congenital vascular abnormalities.

CONGENITAL VASCULAR ABNORMALITIES    

HAEMANGIOMAS -  WHAT ARE THEY?

Also called “strawberry naevi”, “strawberry haemangiomas”, “capillary haemangiomas” and “cavernous haemangiomas”, they get their name from their appearance much like a strawberry in that they are crimson red (sometimes a little blue) in colour with a slightly dimpled surface.  It is not clear what causes them but the small vessels in the skin become enlarged. Many of the names are historical, confusing and inaccurate but all refer to the same thing.  Although often described as birth marks, strawberry naevi are not always present at the time of birth but appear quite rapidly in the first few weeks of life.  60% appear on the head and neck and they can vary dramatically in size.  They are 3 times more common in girls than boys, more common in premature babies and are found in 2 to 3% of all newborns. In 20% of cases, more than one strawberry may appear.  

DO THEY NEED TREATMENT?

A strawberry may continue to grow until it reaches a plateau at around one year of age after which point it will slowly start to regress.  It will become gradually paler and flatter, a process that can continue until the child is 10 years old but most strawberry naevi have disappeared by the age of 2 or 3 years old.  Sometimes there is a slight fatty swelling where the mark used to be.  Because of this tendency to regress spontaneously, treatment is very rarely required and a vast majority of the “birth marks” come and go without ever causing any problems for the child.   In a few rare cases however, a strawberry haemangioma can cause complications such as bleeding, ulceration and infection  The location of the haemangioma can cause problems, for example, if it obscures vision it may affect the development of the child’s sight.  Very large haemangiomas can have other associated complications.  For example, haemangiomas on the skin can be associated with similar lesions in the body organs such as the liver. They can be associated with problems affecting platelets (cell fragments found in the blood that are involved in clotting).  

WHAT TREATMENT IS AVAILABLE?

The complications listed above are very rare and in cases that need treatment, there are a number of different options available including steroid treatment, surgery and even forms of chemotherapy can be used in special cases.    

PORT WINE STAINS/CAPILLARY MALFORMATIONS -  WHAT ARE THEY?

Also known as “nevus flammeus”, and “capillary malformations” these birth marks persist throughout life, are equally common in boys and girls and most commonly involve the face.  The affected skin has a red wine colour due to the presence of dilated capillaries (the smallest blood vessels) in the dermis (the deep layer) of the skin.  The port wine stain (PWS) will grow in proportion to the child and may become darker in colour and develop a more uneven surface in adulthood.  

DO THEY CAUSE PROBLEMS?

Apart from the disfigurement that is perceived, PWS rarely have any symptoms or complications.  There are some rare syndromes associated with PWS such as Sturge Weber syndrome (PWS in the upper part of the face associated with epilepsy and sometimes learning difficulties) and Klippel Trenaunay syndrome (PWS involving the leg, with other underlying vascular abnormalities) . 

WHAT TREATMENT IS AVAILABLE?

 For troublesome disfiguring PWS, laser treatment can be very effective.

OTHER VASCULAR MALFORMATIONS -  WHAT ARE VASCULAR MALFORMATIONS?

Caused by “faulty” development of vessels, these malformations are present at birth but may not be noticed until later in the child’s life. The vessels involved can be veins, lymphatics, arteries or a combination of these.  They can be present on the surface of the body or deep inside organs.  They are rare. ·  

VENOUS MALFORMATIONS

Involving veins, they may be visible as a feint blue patch or swelling and may enlarge if dependent (ie below the level of the heart under the effects of gravity) but can be easily pressed and flattened.  They often cause no symptoms but occasionally can thrombose (ie a blood clot forms inside) causing them to enlarge and become painful.

WHAT TREATMENT IS AVAILABLE?

In troublesome cases sclerotherapy (injection into the lesion) or sometimes surgery can be considered.

LYMPHATIC MALFORMATIONS

Involving the lymph system, include conditions known as lymphangioma circumscriptum, cavernous lymphangiomas and cystic hygromas.  Most lymphatic malformations will be present at birth or will develop before the age of 2 and will not resolve spontaneously. They are equally common in boys and girls.  Their appearance is variable, from small blisters like marks, known as vesicles, on the skin (lymphangioma circumscriptum), to large swellings in the neck, limbs or face etc.  In some cases there can be bleeding or infection causing sudden enlargement.

WHAT TREATMENT IS AVAILABLE?  

If necessary, treatment may involve injection into the swelling or surgery.  The surgery can often be complicated.

ARTERIAL AND ARTERIOVENOUS MALFORMATIONS

Involving arteries abnormally connected to veins they can be very difficult to treat.   They may undergo enlargement triggered by trauma or puberty and complications such as bleeding, ulceration and pain may develop.  There will usually be a visible swelling in the skin over the affected area which is often blue in colour. In some cases the affected area of the body, for example a leg, will hypertrophy (grow beyond normal proportions). 

WHAT TREATMENT IS AVAILABLE?

In some cases surgery can be offered.  The blood vessels involved often need to be accurately investigated before any surgery is undertaken.  The surgeon can then decide exactly what can be done and should explain the options to you at this point.