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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Capillary malformation is a condition included in the group of vascular malformations&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It is one of the most common vascular abnormalities and can affect up to 0&#46;3&#37; of newborns&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> It presents clinically as a homogeneous erythematous macule with well-defined borders&#46; It is typically unilateral and is usually present at birth&#46; However&#44; cases of acquired capillary malformation have been reported in patients with no previous lesions of this type&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Patient 1 was a 9-year-old girl followed-up from her first year of life for mastocytosis presenting as urticaria pigmentosa and treated with sodium cromoglycate and cetirizine&#46; When she was 7 years old&#44; a well-defined pink macule started to become visible&#44; affecting segmentally the area of the first branch of the trigeminal nerve&#44; and the superior part of the area of the second branch&#44; with a more violaceous appearance in the periocular region&#46; She presented no other lesions and there was no family history of interest&#46; Skin biopsy revealed a capillary proliferation&#44; negative for GLUT-1&#44; consistent with a diagnosis of capillary malformation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patient 2 was a girl aged 8 years&#44; with no past history of interest&#46; She was referred to our clinic for macules on the left side of her face&#46; The macules had first been noticed by her parents when the child was 4 years old&#44; and they had grown progressively&#46; Her parents stated that the macules became more evident in hot environments and after physical exertion&#46; On examination&#44; patchy pink macules were observed in a segmental distribution along the left body of the jaw and they were seen to become more intense after the patient performed physical exercise&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patient 3 was a 7-year-old boy with no past history of interest&#46; He was seen for a lesion in the right jaw region&#46; His parents had first noticed the lesion when the child was about 4 years old&#46; They stated that it had been asymptomatic&#44; although its intensity increased with physical activity and with heat&#46; On examination&#44; a patchy pink macule with superficial telangiectasias was observed&#46; The macule became more intense after the child performed physical exercise&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">None of the 3 patients had any family history of interest or presented other lesions&#46; Clinically there was no thrill and the lesions were not detectable on ultrasound&#46; Photos of the children when they were younger were requested to check that the lesions had not previously escaped the parents&#8217; attention&#46; The children were referred to a reference center for laser treatment&#44; which was only rejected by the third patient &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The immense majority of capillary malformations are present at birth or appear in the first years of life&#46; Cases of acquired capillary malformations are rare and were first described in 1939 in a patient who had suffered spinal cord injury&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Ten years later&#44; Fegeler<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> reported a new case of postraumatic capillary malformation&#44; which has been named Fegeler syndrome since that time&#46; The etiological factors that can trigger their de novo appearance have not been identified&#44; though a history of trauma is present in up to a third of cases&#46; Previously it has been proposed that the appearance of congenital capillary malformations could be due to a deficit of sympathetic innervation &#40;responsible for vasoconstriction&#41;&#44; leading to vascular ectasia that presents as this vascular malformation&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Acquired cases associated with spinal trauma conform to this hypothesis&#46; Other possible etiologies have also been proposed&#44; such as estrogenic impregnation&#44; either during pregnancy or in the pubertal-adult period&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> In some isolated cases&#44; capillary malformations have been related with drugs&#44; herpes zoster&#44; sun damage&#44; cluster headaches&#44; and acoustic neuroma&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> In a capillary malformation of the port wine stain type&#44; the possibility of a postnatal mutation of the <span class="elsevierStyleItalic">GNAQ</span> gene might also be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Despite these proposals&#44; no triggering event has been discovered in many cases&#46; The age at onset reported in the literature varies between 3 and 69 years&#44; with a mean age of 25 years&#46; Lesions most often arise on the face and upper limbs&#44; and they have not been associated with other malformations or skin lesions&#46; Typical and acquired capillary malformations are histologically and morphologically indistinguishable&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The differential diagnosis based on the type of vascular lesion is extensive&#46; But perhaps it is most important to rule out this lesion as part of a syndromic diagnosis associated with more serious repercussions than the purely cosmetic&#46; These include capillary malformation-arteriovenous malformation syndrome &#40;a family history of similar lesions or of arteriovenous malformation is usually detected&#44; the capillary malformations are multiple&#44; with a browner color&#44; increased local temperature&#44; a whitish peripheral halo&#44; and possibly with arterial flow visible on ultrasound&#41; and Sturge-Weber syndrome &#40;lesions that affect one side of the face&#44; but that are usually present at birth&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In summary&#44; acquired capillary malformation may be considered simply to be a late-onset capillary malformation with a variable latency period&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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