Vascular Malformations CS-OSPE

Port Wine Stain (Capillary Malformation)

Case Description/Presentation: baby who presents with a lesion on her face that has been present since birth and has been growing in size. The lesion is not itchy or painful. This is a 30-year-old fellow who presented to your clinic with this skin condition, which appeared since birth. Patient came to the clinic with this lesion since birth.

Diagnosis: Cutaneous or mucosal CM (capillary malformation) (“Port-wine” stain) Port Wine Stain / Portwine

Underlying Cause/Problem: Capillary Capillary malformation (sometimes specified as “with midline cut off”)

Description: Dull red patch on the face involving the upper eyelid, forehead, temple and scalp

Differential Diagnosis:

1. Nevus simplex
2. Infantile Hemangiomas (IH)

Management/Treatment:

1. Full history
2. Examination
3. Education
4. Conservative management – no treatment or use of cosmetics to conceal the lesions
5. Pulse dye laser (PDL) – causes intravascular coagulation in abnormal vasculature without damaging surrounding structures

Prognosis/Progression: May develop papules, skin hypertrophy, and nodules over time.

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Nevus Simplex / Salmon patch

Look at this birthmark and answer the following questions.

1. What is the most likely diagnosis and what is the underlying cause?

   • Diagnosis: Nevus Simplex
   • Underlying Cause: Capillary malformation
   • Describe: Flat, pink to bright red patches typically on the midline forehead

2. What is the treatment of choice and what is the prognosis?

   • Treatment: facial lesions fade within 1-2 years making treatment unnecessary.
   • Prognosis: Good. 90-95% of lesions resolve/fade after 1-2 years.

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Infantile Hemangioma

This is a six-month-year baby boy who presented to the dermatological clinic with this condition.

What is the diagnosis?

• Infantile hemangioma (IH) (types: Segmental regional, Superficial, Deep, Mixed, Localized).

What are the typical clinical presentations?

• Bruise-like patch, area of vasoconstriction/pallor or telangiectasias.
• Bright red.
• Minimally elevated.
• Large with bluish color.

What are the recommended treatment options?

• Topical therapies:
  • Pulsed dye laser: for ulceration or residual lesion.
  • Topical corticosteroid: if on the trunk, medium potency or low for 2-3 months.
  • Topical beta blocker.
  • Interalesional corticosteroid.
• Systemic therapies:
  • Immunosuppressive anti-plastic therapies: interferon, vincristine.
  • Oral propranolol.
  • Systemic corticosteroid.