Vascular Birth Marks (VBM)

There are many different types of vascular birthmarks. They can be congenital (present at birth) or acquired (formed after birth). VBM vary in size, shape and thickness. Birthmarks are either caused by an abnormality in the blood vessel (vascular malformation) OR from overgrowth of cells that make up the vessel eg haemangioma.

Generally the name given to the birthmark is determined by the type of blood vessel that is abnormal. For example, a capillary vascular malformation is due to malformed dilated capillaries in the skin whereas venous malformations are secondary to abnormal veins. Capillaries are the tiny end vessels that feed into the skin whereas veins are the vessels that take blood away from the skin. Capillary malformations usually appear as superficial flat red or purple skin discoloration whereas venous malformations are deeper and often have a blue hue.

Port wine stains

Port wine stains (PWS) are uncommon vascular malformations. They are characterized by purple or dark red skin and commonly affect one side of the face, frequently with a sharp cut off in the mid-line of the face. These do not reduce in size overtime, and may become thicker and more purple as a child grows older.

Rare syndromes can be associated with some types of vascular birth marks (eg Sturge Weber, Parkes Weber, Klippel-Trenaunay and Proteus syndrome) and for this reason children with complex birthmarks warrant review by a multidisciplinary team of specialist.

Vascular laser therapy can improve the appearance of PWS. Treatment prior to school entrance helps children psychologically, and frequently laser treatment is commenced in babies. Improvement by up to 70% can occur after 6 to 10 (sometimes less) sessions of PDL therapy. The midface is often slower to respond to treatment than the outer face and legs do not respond as well as the face.

Haemangiomas

Haemangiomas are not malformations, but rather are due to overgrowth of the cells that make up blood vessels (endothelial cells). These lesions are more common in premature babies and commonly go through a rapid proliferating phase which is followed by regression and involution. 20% involute by 2 years of age, 30% by 3 years, 40% by 4 years and so forth. Care must be taken if haemangiomas are abnormally large, multiple, in unusual sites such as around the eyes, on the genitals or near the wind pipe.

Early specialist intervention is necessary in these cases to prevent avoidable severe complications. Haemangiomas can cause significant psychological distress, but help is readily available from specialists with knowledge in the management of these lesions.