Cutis marmorata telangiectatica congenita (CMTC)

At Children’s Hospital Boston, we consider you and your child integral parts of the care team and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.

Undoubtedly, you were distressed when your child was diagnosed with cutis marmorata telangiectatica congenita (CMTC). That’s understandable—every parent wants their child to be healthy. But we can’t emphasize enough that most of the time CMTC won’t cause any other problems for your child.

The purple, marble-like pattern fades on its own over the first year as your child’s skin matures and thickens. Your child’s doctor will probably recommend observation after making sure that no other abnormalities are present.

What are our options for cosmetic treatments?

Having a birthmark can be psychologically or socially difficult, and you may decide that  after it’s faded, you’d like to treat your child’s CMTC with laser therapy.

At Children’s, we use a device called a pulsed dye laser to destroy the abnormal blood vessels (telangiectasias) that remain after the CMTC has faded. Pulsed dye laser is the gold standard of treatment for telangiectasias because it is highly effective and rarely causes any scarring.

How does it work?

First, the doctor “tunes” the laser to a specific wavelength of light. It produces a bright light that is absorbed by blood vessels. The abnormal blood vessels are then destroyed without damaging the surrounding skin.

What’s the treatment like?

Your child’s physician holds a wand against the skin and "pulses" the laser for about a minute. It should only take one or two treatments to destroy the blood vessels and lighten your child’s skin.

During the treatment, your child wears eye protection because laser light can potentially harm the eyes.

Is the treatment painful?

Not really. The laser light feels a bit like a rubber band snapping against the skin. Afterwards, your child may feel a bit of pain equivalent to a minor sunburn.

If you’re worried about your child’s reaction to the discomfort, we can give her a topical anesthetic. Tylenol can also help reduce the pain.

Are there any side effects?

There are a few minor side effects:

• Immediately after the treatment, your child’s skin will be purple where the laser was focused.
  • This lasts for seven to 10 days.

• As the purple fades, the treated area may still look red, but will slowly fade to normal skin color over the next few weeks.

• In a few kids, crusting may develop in the first several days and last up to two weeks.

• Some kids may experience a temporary brown discoloration of the skin for several months.

What else do we need to know about the treatment?

• Avoid direct exposure to the sun for three weeks prior to the treatment. Sunburn and suntan may absorb the laser light and make the treatment less effective.
• You should also avoid sun exposure for several months after the treatment. We recommend always applying a sunscreen with SPF 15 or greater.
• Avoid aspirin and aspirin-like products for 14 days prior to treatment.
• You may want to apply antibiotic ointment and a bandage to your child’s skin immediately after treatment.

Should your child develop any of the complications related to CMTC, we’ll refer him to the appropriate specialists to design a treatment plan.

Follow-up care

A schedule of follow-up care will be determined by your child's physician and other members of your care team. The main purpose of these follow-up appointments will be to ensure that the CMTC is not affecting the growth of your child’s limbs.

While there are no lasting effects of CMTC, as your child gets older, he may be uncomfortable with the skin lesion, especially if it’s in a prominent location such as on the face or neck. Our counselors can help your child deal with the psychological and social issues related to having a birthmark.

Coping and support

We understand that you may have a lot of questions when your child is diagnosed with CMTC.

• Will it go away?
• Is it a sign of anything else?
• How will it affect my child long term?
• What kinds of treatment are there?
• What do we do next?

We’ve tried to provide some answers to those questions in the following pages, but there are also a number of other resources to help you and your family.

Parent to parent: Want to talk with someone whose child has been treated for CMTC? We can often put you in touch with other families who can share with you their experience at Children’s.

Patient education: From the first office visit, our nurses will be on hand to walk you through your child’s treatment and help answer any questions you may have—What symptoms might my child have? What do we do next? They will also reach out to you by phone, continuing the care and support you received while at Children’s.
 
Faith-based support: If you are in need of spiritual support, we will help connect you with the Children’s chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.

Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial difficulties.

On our For Patients and Families site, you can read all you need to know about:

• getting to Children’s
• accommodations
• navigating the hospital experience
• resources that are available for your family

And here are a few helpful links to pages with more information about CMTC:

• Our Vascular Anomalies Center has a page with links to organizations that offer support and education for parents who have a child with a vascular anomaly.
• The National Organization of Vascular Anomalies has an informative site.
• You can also find an active, online support group at the web site of the Vascular Birthmarks Foundation.