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Vascular birthmarks in children

 

This guideline applies to children from birth

 

Introduction

  • Port wine stains are associated with congenital glaucoma, Sturge-Weber syndrome (intracranial angiomas) and Klippel-Trenaunay syndrome (limb hypertrophy).
     
  • A capillary haemangioma (strawberry naevus) is a benign self-limiting overgrowth of blood vessels.  They are common and affect up to 1 in 10 infants.  60% occur on the head and neck but can affect any part of the body internally or externally.  Most cases are unilateral.  

 

In scope   

  • Port Wine Stains & Capillary haemangiomas


Not in scope    

  • Congenital naevi & Congenital dermal melanocytosis

  
 

Red Flag Features

  • Capillary haemangiomas causing functional impairment (eg affecting breathing, feeding or near/on scalp, eye, midline of neck, base of spine).
     
  • 5 or more haemangiomas may indicate internal lesions/underlying condition and requires further investigation.


 

Investigations required prior to referral

None required


 

Management optimisation

  • Capillary haemangiomas develop over the first few weeks of life and can continue to grow until approximately 12 months of age. Following this, they shrink and fade slowly usually complete by 5-7 years.  They may disappear completely or leave a permanent mark
     
  • Most do not require treatment and parents only need reassurance
     
  • Photographs at 6–12-month intervals are very useful
     
  • A capillary haemangioma’s surface is often dry and fragile, parents should avoid using bubble bath/soap on lesions and can apply a layer of petroleum jelly (e.g. Vaseline) twice daily to prevent drying out
     
  • Ulcerated lesions require referral (see below), but a non-adhesive dressing can be applied in the interim - however these will require close monitoring.


 

Advice and Guidance

  • Please send advice and guidance to Paediatric Dermatology via eRS.  Please use this service if there is uncertainty about management
     
  • Port Wine Stains

  • Refer large port wine stains or on cosmetically sensitive sites via advice and guidance for an early dermatology opinion, as laser may be indicated, and onward referral can then be made to tertiary centres such as Bristol Children’s Hospital or Great Ormond Street Hospital
     
  • Cosmetic treatment of Port Wine Stains are not routinely commissioned and will not normally be funded by KCCG though a clinician may request exceptional funding.


 

Referral

Emergency and red flags- likely to be identified soon after birth

Capillary Haemangiomas located near:

  • nose or mouth – if any signs of impaired breathing or feeding
  • base of spine – possible underlying spinal pathology
  • scalp – possible underlying cranial pathology if large/multiple
  • midline on neck – possible underlying laryngeal pathology
  • close to or on eye – can cause visual impairment/impair development of orbit structures/glaucoma


Contact on - call Paediatrician via switchboard for same day assessment.

 

Urgent referral criteria

  • Anogenital areas
  • 5 or more haemangiomas may indicate internal lesions/underlying condition

and requires further investigation

  • Bleeding or infection; more common if ulcerated lesion
  • Large (>2cm) capillary haemangiomas at risk of causing significant cosmetic or functional impairment for consideration of early propranolol therapy.
  • Large facial lesions or affecting the whole limb


Refer to Paediatric Dermatology by letter, include photographs if possible.


 

Supporting Information

For professionals

 

For patients

 

References

 

Page Review Information 

Review date

12 December 2025

Next review date

12 December 2027

Clinical editor

Dr Melanie Schick

Contributors

Dr Vandana Jones, Consultant Dermatologist, RCHT