A paediatricdermatologist, paediatrician, vascular specialist or surgeon should assess significant infantile capillary malformations or infantile haemangiomas, especially when large, symptomatic (especially when ulcerated), located on the head and neck or close to eye, nose or mouth.
Vascular naevus
Vascular naevi or anomalies are present at birth or appear in early childhood. They are classified according to the size and type of vessel. They may remain stable or become more prominent with maturity. There are various associated syndromes.
Naevus anaemicus – in this naevus, blood flow is interrupted resulting in pale areas.
Capillary vascular malformation
Lymphatic malformation
Naevus anaemicus
Angioma
An angioma or haemangioma is a benigntumour formed by the dilation of blood vessels or the formation of new ones by the proliferation of endothelial cells.
Infantile haemangioma (superficial, deep, or mixed): proliferates in the first few weeks of life, followed by involution later in childhood. These are sometimes syndromic, as in PHACE, LUMBAR and PELVIS syndromes.
Glomeruloid haemangioma is an eruptive form of haemangioma typically diagnosed in POEMS syndrome
Congenital haemangioma is at full size at birth and may rapidly involute (RICH) or persist (NICH)
Kaposiform haemangioendothelioma is a rare aggressive haemangioma that results in platelet trapping — the Kasabach-Merritt phenomenon.
Tufted angioma: rare childhood tumour with characteristic histology.
Cherry angioma: adult onset, common degenerative lesions, usually multiple
Angiokeratoma: acquired scalyangiomas, usually on vulva or scrotum, or in association with Fabry disease
Glomus tumour: tender papule on nail bed or palm arising in young to middle-aged adult
Pyogenic granuloma occurs in children and young adults on skin and mucosa, most often lower lips, fingers and toes. It may develop in response to a minor injury, in pregnancy, or when taking certain medications. It grows rapidly and may become pedunculated or polypoid and surrounded by a collarette of normal skin. It bleeds and crusts.
Bacillary angiomatosis is a rare opportunistic bacterialinfection due to Bartonella henselae.
Infantile haemangioma
Cherry angiomas
Venous lake
Telangiectasia
Prominent cutaneous blood vessels can be physiological or pathological.
There are some named conditions in which telangiectasia is (or telangiectases are) characteristic.
Telangiectasia eruptiva macularis perstans, a form of mastocytosis
Spider telangiectasis consists of central arteriole and radiating capillaries. Very common in healthy individuals, but more arise in response to oestrogen, often in pregnancy, liver disease.
Venous lake: blue or purple compressible papule due to venous dilation, often on lower lip or ear.
Unilateral acquired telangiectasia: telangiectasia with naevoiddistribution.
Acquired lymphangiectasia: “frog-spawn” appearance that follows lymphatic obstruction eg tumour or surgery.
Spider telangiectasis
Essential telangiectasis
Hereditaryhaemorrhagic telangiectasis
Malignant vascular tumours
Kaposi sarcoma: four types are recognised due to Human herpesvirus 8 (HHV8). Multiple purple macules, papules and plaque on the skin and mucous membranes develop.
Angiosarcoma: idiopathic or secondary to chronic lymphoedema or radiation. Often aggressive, it mostly presents in elderly people with spreading purple patches and plaques that may bleed and ulcerate.
