Angiomas or vascular abnormalities [EN]

Angiomas or vascular abnormalities mainly comprise haemangiomas of the infancy and vascular malformations : capillary malformations (capillary nevus or port wine stain), lymphovascular, veinous and arterial malformations.


hemangiomeHemangiomas are found in 4 to 10% of infants, with a marked female predominance, increased prevalence in low birth weight neonates. Prenatal associations include multiple gestation, placenta praevia, and pre-eclampsia. Hemangiomas typically appear during the first weeks of life. Their natural history includes an early stage of rapid proliferation followed by a plateau and a slow involution over 5 to 6 years. The rapid growth phase is variable in duration and may last for a few weeks to one year.  The involution process begins at approximately 12 months of age and continues over the next 5 to 7 years. Hemangioma become progressively paler and less firm at palpation. At the age of 5-6, almost 70% of hemangiomas completely disappear, although minimal skin sequels remain in about 30% of cases. Cutaneous hemangiomas can be superficial, deep or mixed. Sometimes they are found in visceral locations (liver mostly). Superficial lesions are well delimited and often feature the classic so-called strawberry hemangioma. Those within the deep dermis or subcutaneous tissues often present as pale blue or purple firm and elastic masses. Finally, mixed forms associate a superficial component surrounding a deeper sub-cutaneous haemangioma. It should be noted that many hemangiomas do not need any treatment, however, 5-15% of  them require consulting a specialist because of complications (superficial ulceration, expanding volume with a risk of compression of vital organs). In accordance with the type of hemangioma and child’s age, various treatment can be proposed included betablockers, corticosteroids, laser or surgery.

PORT WINE STAINS (superficial vascular capillary malformations, capillary nevus):

angiome planCapillary nevus is present at birth and persists over life. The lesion has no tendency to expand but will increase proportionally to the growth curve. Capillary nevus is mostly an aesthetic problem; however its localisation in a certain skin area may be associated with complications. Sturge-Weber-Krabbe syndrome associates capillary nevus of the face and meningeal angioma with or without glaucoma. The risk area for capillary nevus corresponds to the ophtalmic branch of the trigeminal nerve (forehead and upper eyelid). This type of capillary nevus should be distinguished from another form of vascular birthmark that affects symmetrically the forehead and one or the two eyelids. In addition, capillary nevi of the lower limb may be the cause of abnormal growth in length and diameter of the involved limb that necessitates an orthopaedic coverage. Currently the most effective treatment for the capillary nevus is the pulsed dye laser. Several treatment sessions are necessary to obtain satisfactory results (4 to 6 usually). In most cases, the pulsed dye laser only allows to make the lesion paler.


Lymphangiomas may present as soft subcutaneous cysts and are named cystic hygroma. They are rather localized in the head and neck region. The main complication of these lesions is the occurrence of painful inflammatory episodes, which may lead to a secondary cure. Lymphangioma circumscriptum is another type of lymphangioma and the commonest type. It presents as small hemorrhagic or translucent vesicles that may arise on the surface of the skin. These vesicles may be isolated or grouped resembling frog spawn. Lymphangioma may be present more atypically with only hypertrophy of the subcutaneous tissues without cutaneous symptoms. The treatment of lymphangiomas is difficult. Macro (large) cystic lesions of lymphangioma may be surgically removed or treated with sclerotherapy. Microcystic lesions are usually not accessible to therapy.


Venous malformations present as single or multiple compressible lesions, blue or purple resembling varicose veins that tend to increase in size during efforts.  
They may become painful because of  thrombosis. These malformations are usually under the influence of hormones. Indeed, they often aggravate at puberty or during pregnancy. Treatment is difficult and is not the rule unless the lesions are limited and accessible for surgery. In most cases, definitive therapy is not possible and partial therapy such as sclerosis of larger lesions is proposed and/or surgical removal to decrease size of the lesions.


During childhood, arteriovenous malformations are usually in a dormancy phase. At that time, they may mimic a capillary nevus. Clinical signs that should alert include increased local heat and extension/increased volume of the lesion which is unusual in the case of a capillary nevus. In the context of puberty, the lesion may increase. Evolution during lifetime, and especially during pregnancy, is unpredictable and the malformation may develop and expand into the neighboring tissues (skin, muscles, or even bones). Treatment is very challenging and typically care requires a multidisciplinary approach (dermatologists, radiologists and surgeons).




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Léauté-Labrèze C, Taïeb A. Caution with regard to the efficacy of interferon alfa-2b in the treatment of giant hemangiomas. Arch Dermatol. 1998 Oct;134(10):1297-8. PubMed PMID: 9801696.