The skin protects you from the environment and at the same time prevents loss of proteins, salts, water and heat from the body. Within dermatology, there are hundreds of diseases of the skin. Vascular anomalies are defects that are visible within the skin (sometimes you only see a swelling) by change of (blood) vessels. There are various types vascular abnormalities.

The vascular anomalies can be classified into two groups: the vascular malformations and vascular tumors. See the table below with examples.

 Vascular malformations  Vascular tumors
 Capillary malformation (e.g. Nevus flammeus)     Hemangioma (infantile Hemangioma = IH) 
 Telangiectasias (eg. ' spider Nevus ')  Congenital Hemangioma (NICH/RICH)
 Venous malformation  Granuloma telangiectaticum
 AV malformation  Hemangio-endothelioom
 Lymphatic malformation  Tufted angioma
 Complex mixed malformation/syndrome   






There are multiple formats. Some people share the deviations, for example, by looking at the speed of the blood through the vessels: "high-flow" and "low-flow". In the past, most vascular diseases referred to as 'Hemangioma'. However, this is unwarranted, because different vascular disease etiology, course, or another treatment. Nowadays we talk, if we are talking about real Hemangiomas, rather about infantile hemangiomas (infantile hemangioma, IH).

Vascular abnormalities may not always cause problems but need to be checked. It is good to always good to have  a "birth spot" or stain checked (we are not talking here about moles). We can distinguish the two groups, as said a group that is not causing problems (non-alarming) and a group that is causing problems (alarming).

In the case of vascular malformations, the family doctor will almost always refer you to a specialist such as (children's) dermatologist or child surgeon for non-alarming abnormalities to get the correct diagnosis.  For alarming defects you may be referred by the doctor to a special multidisciplinary team of specialists.

When treating hemangiomas there are many developments occurring in the treatment of these. Patients with non-alarming hemangiomas do not need to be redirected because they usually do not need to be treated. The GP will monitor these deviations. Should there be any cosmetic objections or doubts the GP may then refer the patient to the (children's) dermatologist. For alarming hemangiomas the family doctor can refer you to a multidisciplinary team of specialists.

Vascular abnormalities: when and to whom should you redirect?


 Preferred Advice

 Vascular malformations  Always refer you to family doctor/pediatrician to diagnosis.
 Not alarming  Redirect to (children's) children's dermatologist or surgeon.
 Alarming  Redirect to multidisciplinary team.
 Infantile hemangiomas  Redirect to family doctor or pediatrician depending on severity and treatment indication.
 Innocent, not alarming  Guide by GP themselves or interested pediatrician.
 Cosmetic concerns and/or potentially alarming    Redirect to (children's) dermatologist (e.g. superficial IH in face or 'precursor lesion').
 Alarming  Redirect to multidisciplinary team.


 On the following pages you will find more information by deviation:

  1. AV malformation.
  2. Capillary malformation.
  3. CMTC (Cutis Marmorata Telangiectatica Congenita).
  4. Complex mixed malformation.
  5. Congenital Hemangioma (NICH/RICH).
  6. Granuloma telangiectaticum.
  7. Hemangio-endothelioom.
  8. Infantile Hemangioma.
  9. Klippel-Trenaunay.
  10. Lymphatic malformation.
  11. Stork bite/Angel's kiss.
  12. Telangiectasias ('spider Nevus').
  13. Tufted angioma (and Kasabach-Merritt syndrome).
  14. Venous malformation.
  15. Wine Stain (Nevus flammeus) and Sturge-Weber Syndrome.

Finally, another overview of multidisciplinary teams including contact details.

Thanks to Sherief R. Janmohamed MSc MD (The Netherlands).

The photos are brought to you by Prof. Dr. Arnold p. Orange-with permission from parents and owner.


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