Capillary Vascular Malformations: Port Wine Stains

Capillary vascular malformations look like irregular patches of pink or purple skin that can occur anywhere on the head, body and extremities. They occur in 3 out of every 1,000 births, and the pink color is due to dilated capillary vessels in the dermis layer of the skin.

Commonly called port wine stains, capillary vascular malformations are present at birth and do not go away. They grow proportionately with the child, and although they do not spread out to cover unaffected skin, they can darken and thicken as the vessels slowly dilate when patients reach adulthood.

Capillary vascular malformations that are located on the upper third of the face may also involve the eye and the central nervous system (Sturge-Weber syndrome). Periodic evaluation by an ophthalmologist beginning in infancy is recommended because of the risk of glaucoma. Patients with central nervous system involvement can have seizures, and your pediatrician may order a brain MRI scan to monitor for potential complications.

Capillary vascular malformations may also be accompanied by deeper abnormal vessels such as veins and lymphatics (Klippel-Trenaunay syndrome), or arteries and veins (Parkes-Weber syndrome).

The treatment of choice for capillary vascular malformations is the pulsed yellow dye laser. The laser light is absorbed by the blood inside the vessels, which causes them to heat up rapidly and burst. The treatment causes temporary bruising and then gradual lightening of the pink or purple color. Your doctor will decide whether the treatments can be done in the office using a local anesthetic cream, or if it may be desirable to perform the treatments under a brief general anesthetic in the operating room.

Before undergoing laser treatments, patients should understand that multiple laser treatments are necessary to achieve the best results, and that the laser cannot completely remove the color. The lasers currently available cannot penetrate deeply enough to reach all the vessels; therefore treatment is discontinued once improvement is no longer visible. Different parts of the body may respond differently to the laser. The laser tends to be less effective when used closer to the hands and feet, so laser treatment of the face and neck is generally more successful than that of the extremities.

Laser treatment of head and neck capillary vascular malformations is usually covered by insurance, but treatment elsewhere on the body may not be. We recommend consulting your insurance company to request preauthorization for laser treatment and determine the likelihood of coverage.