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Capillary Haemangioma

Four varieties of capillary haemangioma are seen

• Salmon patch
• Port-Wine stain
• Strawberry angioma
• Vin Rose patch.

Spider naevus, a type earlier included in capillary hemangioma actually arises from skin arteriole and not a true capillary haemangioma.

Salmon Patch

• This is present since birth
• It usually disappears before the first birthday
• It is mostly seen over the middle of the forehead, or occiput or anywhere in the midline.

Port-Wine Stain

• It is usually present since birth and does not show any change for the rest of the life. The size gradually varies in proportion to the whole body.
• Common on the face, at the shoulders, neck and buttock.
• This is deep purple-red in colour which may become paler in later life.
• It is a diffuse vascular deformity. It may become nodular in some areas.
• With pressure the colour diminishes in intensity, but when the pressure is released the colour of the naevus takes time to reappear as the feeding vessels are also abnormal.

Strawberry Angioma

• Red mark is noticed after 1 to 3 weeks of birth that gradually increases in size comparatively rapidly for a few weeks or months till it takes a typical strawberry or raspberry-like swelling.
• After the first birthday the angioma gradually regresses in size and may disappear by the age of 7 to 8 years.
• The subcutaneous tissue as well as the skin is often involved. Sometimes muscles may be affected. Very rarely submucous strawberry angioma has been seen when it is prone to alarming haemorrhage.
• The lesion is composed of immature vascular tissue.
• This angioma is usually 1 to 2 cm in diameter, but this may become as large as upto 8 cm in diameter. Strawberry angioma is soft, compressible and not pulsatile. Sustained pressure will squeeze most of the blood out of the haemangioma leaving it collapsed. As soon as the pressure is released refilling occurs quickly. It is usually seen in the skin and is freely mobile with the skin.

Vin Rose Patch

It is a congenital intradermal vascular abnormality in which there is mild dilatation of vessels in the skin. This lesion takes a pale pink colour.

It may be associated with other vascular abnormalities e.g. extensive haemangiomata, arterio-venous fistula in the limb leading to giant limb lymphoedema etc.

This lesion can occur anywhere in the body. It does not cause any symptom. It is not dark enough to produce disfigurement. It is often accepted as minor birthmark and is of the forgotten about.

Treatment of Capillary Hemangioma

Majority of the capillary haemangiomas disappear on their own. So it is worthwhile to wait and watch.

If the lesion exists even after 8 years and the patient and the parents insist on treatment for cosmetic reason, the following are the treatment options available

• Excision of the lesion with skin grafting.
• Carbondioxide snow application.
• Injection of hot water or hypertonic saline or sclerosing agent
• X-ray therapy has not proved very successful, yet may be considered in failure cases though it may cause disturbances of growth, necrosis of skin, pigmentation and ulceration.
• Injection of steroid.

CO2 or ND Yag Laser is now the treatment of choice when this expertise is available. This treatment is particularly useful in port-wine stain.