What is a capillary malformation?

Capillaries (the smallest vessels in the body) can dilate in the superficial part of the skin, a condition known as capillary malformation.

They are red, sometimes pink, flat and well-defined. In common parlance, they're also known as "wine spots".

Often visible from birth, the size of these vessels gradually increases with age, which may explain why the spot takes on a darker color. These lesions persist for the rest of the individual's life.

What causes capillary malformations?

The cause of this malformation is unknown, but somatic mutations in the GNAQ/GNA11 genes have recently been identified.

Capillary malformations are congenital skin lesions. They are therefore present from birth. Capillaries are formed during embryogenesis, i.e. at the start of embryonic life (^1st trimester of pregnancy).

In no case are parents responsible. No food, medication or activity ingested during pregnancy is responsible for the appearance of a capillary malformation.

How are capillary malformations diagnosed? Where are they located?

These malformations can occur anywhere on the body.

Diagnosis is usually made on clinical examination. Ultrasound with a Doppler technique is sometimes used to visualize the blood vessels.

When should I consult a specialist?

In newborns, close monitoring is required during the first months of life, as this angioma planus may be associated with other vascular malformations. It is then said to be a false angioma planus.

If the capillary malformation covers :

- A part of the forehead or upper eyelid, it is necessary to complete the workup with an MRI or brain scan to look for any vascular malformations in the eye and brain.

- A part of a limb (arm or leg), we need to make sure that the veins and arteries are normal.

If there are no other associated signs and the evolution is stable, it's an isolated angioma planus. In this case, there is no serious factor, and the problem is more cosmetic.

What developments are possible?

If the angioma planus is isolated, a possible evolution is the thickening of the surrounding skin and the appearance of fleshy skin buds (botriomycomas), which can be unsightly and/or cause bleeding.

How can capillary malformations be treated?

If the capillary malformation causes significant aesthetic discomfort, pulsed dye laser treatment may be proposed. This laser produces an energy that is almost totally absorbed by the hemoglobin contained in the abnormally dilated blood vessels under the skin, causing their destruction. A cooling jet reduces the skin temperature a fraction of a second before each pulse to reduce the risk of burns.

This is done under local anaesthetic, and you may feel a painful sensation like a rubber band.

In certain cases, such as significant tissue hypertrophy, the appearance of pyogenic granulomas or botriomycomas, surgical intervention may be proposed.