Capillary malformation of the lower lip is a birthmark made from many tiny blood vessels (capillaries) just under the skin of the lower lip. Doctors often call this kind of mark a capillary malformation or port-wine stain because it looks pink, red, or purple like red wine. It is usually present at birth or appears very soon after birth and tends to stay for life. In this condition, the blood vessels in a small area of the lower lip are wider than normal and stay open all the time. This makes the skin in that spot look darker and sometimes slightly swollen. The mark may be only on the outer lip, only inside the mouth, or on both sides of the lip tissue.
Capillary malformation of the lower lip is a birthmark made of many tiny, permanently widened blood vessels (capillaries) in the lip skin and mucosa. It usually appears at birth as a flat red or pink patch, and over time it can darken to purple or burgundy and sometimes thicken or become uneven. In many children this lesion is isolated, but in others it is part of CLAPO syndrome, a rare condition in which a midline lower-lip capillary malformation is associated with lymphatic malformations of the face/neck and body overgrowth due to PIK3CA gene changes.
These lesions are often called “port-wine stains” or capillary vascular malformations and do not fade by themselves like many infantile hemangiomas. They grow slowly with the lip, may cause cosmetic concern, bleeding after minor trauma (biting, dental procedures), crusting, or difficulty keeping the lip moist. Diagnosis is usually clinical by a dermatologist, pediatrician, or vascular-anomalies team; imaging is used when deeper components or combined venous/lymphatic malformations are suspected.
Capillary malformation of the lower lip can happen alone, or it can be part of a rare syndrome called CLAPO syndrome (Capillary malformation of the lower lip, Lymphatic malformation of the face and neck, Asymmetry, and Partial/generalized Overgrowth). In CLAPO, the lip mark is often the first visible sign, and later the child may show swelling in the neck or face and differences in body size.
Most of the time, this type of lesion is benign, which means it is not cancer. However, it can slowly get darker, thicker, or more bumpy over many years. Because it is on a very visible part of the face, it can also affect how a person feels about their appearance and confidence.
Other names and simple types
Doctors and researchers use several names for this problem. All of these mean almost the same thing, but they remind us of slightly different details:
Capillary malformation of the lower lip – the most direct technical name.
Port-wine stain of the lower lip – used because the color looks like port wine and it is a classic type of capillary malformation.
Nevus flammeus of the lip – another medical term for port-wine stain.
Capillary vascular malformation of the lip – stresses that the abnormal vessels are capillaries and small veins.
CLAPO-type capillary malformation – when the lower lip lesion appears as part of CLAPO syndrome and PIK3CA-related overgrowth.
Doctors also think about simple types based on how the lesion looks and behaves:
Isolated lower lip capillary malformation – mark only on the lower lip, with no other body problems.
CLAPO-associated lip malformation – lower lip lesion plus lymphatic malformations of head and neck and body overgrowth.
Flat (macular) type – smooth, flat, pink or red patch limited to the lip surface.
Hypertrophic or nodular type – older lesion that becomes thicker, bumpy, or “cobblestone-like” and may bleed more easily.
Mixed vascular malformation – capillary malformation in the lip combined with deeper venous, lymphatic, or arteriovenous malformations.
Causes
Scientists now know that most capillary malformations, including those on the lower lip, are caused by genetic changes that happen only in the affected patch of skin, not in the whole body. These are called somatic mosaic mutations, and they change how blood vessel cells grow and relax.
Below, “cause” includes both the main reasons the mark forms and the things that make it darker, thicker, or larger over time.
Somatic mutation in the GNAQ gene in lip blood vessels
Many facial capillary malformations and port-wine stains are linked to a change in a gene called GNAQ in the cells that line the blood vessels. This mutation appears only in the lesion, not in the rest of the body, and it keeps the vessels wider and more active than normal.Somatic mutation in the PIK3CA gene in CLAPO syndrome
In CLAPO syndrome, the capillary malformation of the lower lip is usually caused by a gain-of-function mutation in PIK3CA, a gene that controls cell growth and the PI3K–AKT pathway. This mutation drives overgrowth of blood vessels, soft tissue, and sometimes bone in the head, neck, and limbs.Other rare somatic genetic changes in vessel-growth genes
Some capillary malformations in the face and lips show mutations in other genes like KRAS, BRAF, NRAS, EPHB4, or MAP2K1, which also affect blood vessel signaling. These changes are less common but support the idea that abnormal signaling in vascular cells is a key cause.Early developmental error in facial blood-vessel formation
During early pregnancy, networks of vessels form in the face and mouth. In capillary malformation, one small area does not mature normally and stays as enlarged, low-flow capillaries, which later appear as a stable birthmark on the lip.Mosaic pattern of affected cells (only part of the face is involved)
Because the mutation happens after the embryo starts to divide, only a patch of cells carries the change. This mosaic pattern explains why the mark is limited to the lower lip and sometimes to one side of the face.Association with CLAPO syndrome (capillary + lymphatic + overgrowth)
In CLAPO, the same abnormal vascular signaling that causes the lower lip malformation also causes lymphatic malformations and body overgrowth. So, the capillary malformation of the lip can be seen as a visible “surface sign” of this deeper vascular overgrowth process.Association with PIK3CA-related overgrowth spectrum (PROS)
CLAPO is part of a broader group of disorders called PIK3CA-related overgrowth spectrum, where PIK3CA mutations cause segmental overgrowth and multiple vascular malformations, including capillary malformations on the face and lips.Association with other vascular-overgrowth syndromes (rare)
Port-wine stains on the face can be part of conditions such as Sturge–Weber or Klippel–Trénaunay syndromes, which combine capillary malformations with eye, brain, or limb problems. Lower-lip-only lesions are less typical but remind doctors to check for signs of these syndromes when birthmarks are extensive.Non-inherited, sporadic occurrence
Most capillary malformations, including lower lip lesions, are not passed down from parents. They appear “out of the blue” in a single child because the somatic mutation happens randomly in the developing embryo, so family members usually do not have the same mark.Natural growth of the child
As the child grows, the lip and face grow, and the malformed vessels enlarge with the surrounding tissues. The mark usually stays in the same area but can look bigger simply because the lip itself is larger with age.Age-related darkening of the lesion
Over time, many port-wine stains change from light pink to deeper red or purple and sometimes become nodular (“cobblestone”). This is due to ongoing dilation and thickening of the abnormal vessels, not because the lesion is turning into cancer.Hormonal changes in puberty
Puberty can increase blood flow and vessel reactivity in the skin. Some patients and clinicians notice that capillary malformations, including lip lesions, darken or become more raised during teenage years, likely due to hormonal influences on vascular tone.Hormonal changes in pregnancy (for adults)
In pregnant adults with facial or lip port-wine stains, the lesion may become more swollen, darker, or prone to bleeding. Pregnancy hormones can increase blood volume and vessel dilation, which can temporarily worsen the appearance of existing malformations.Repeated trauma or lip biting
Biting the lip, rubbing it, or accidental injuries can damage the fragile abnormal vessels in the malformation. This can cause bleeding, scabs, and later small nodules or thicker areas as the tissue repairs itself.Local infection or inflammation near the lesion
If the lip gets infected (for example, after dental work or trauma), the extra inflammation and blood flow can temporarily make the capillary malformation more swollen or darker. Usually the color improves once the infection is treated.Associated lymphatic malformations in CLAPO
In CLAPO, lymphatic malformations of the face and neck can add extra swelling, small blisters, or fluid-filled sacs near the lip mark. This mixed vascular problem can make the lower lip look more bulky and uneven.Combined capillary–venous malformations in the lip
In some cases, the lip lesion includes not only capillaries but also enlarged veins or small arteriovenous channels. These extra abnormal vessels can increase the size and thickness of the lip lesion and make planning treatment more complex.Underlying overgrowth of bone or jaw
Some port-wine stains on the face and mouth are linked with slow enlargement of the teeth, gums, or jaw under the lesion, especially in long-standing facial lesions. This structural overgrowth can make the lower lip look more prominent or asymmetrical.Unknown or not yet discovered molecular factors
Research shows that not all capillary malformations can be explained by known gene mutations, and many molecular pathways are still being studied. So, in some patients, the cause remains unknown even after genetic testing.Possible low-level genetic susceptibility
Very rarely, families may have more than one person with vascular malformations, suggesting a background tendency. However, for most patients with a lower lip capillary malformation, the lesion is still considered sporadic and mosaic rather than simply inherited.
Symptoms
Flat pink or red mark on the lower lip at birth
The most common first sign is a well-defined, flat pink or red patch on the lower lip that is visible at or shortly after birth. Parents often notice that the mark does not fade like many simple newborn rashes or “salmon patches.”Color that becomes darker over time
As the child grows older, the color of the lower lip mark may deepen to a darker red, maroon, or purple. This change usually happens slowly over many years and reflects enlargement of the abnormal vessels.Thickening or “cobblestone” texture of the lip
In some teenagers or adults, the lip lesion becomes thicker and bumpy and can look like cobblestones or small raised nodules. This is especially seen in long-standing port-wine stains that have not been treated.Swelling or enlargement of the lower lip
The affected lower lip can slowly become larger than the other side because of extra blood vessels and sometimes overgrowth of the soft tissues beneath. This can make the smile look uneven.Visible border between normal and affected skin
The mark usually has a clear edge where the color changes from normal skin to the lesion, which helps doctors recognize it as a vascular malformation rather than simple irritation or eczema.Bleeding after minor injury
Because the vessels are fragile and close to the surface, the lip may bleed more easily if it is bitten, cut, or scraped. Bleeding can sometimes be brisk but usually stops with pressure.Occasional pain or burning after trauma
Most of the time the lesion is painless, but after a knock or cut, the area may feel sore, tender, or burning for a short time due to local inflammation and small clots in the vessels.Dryness or cracking of the lip surface
Some people notice that the colored part of the lip is drier, with fine cracks or small crusts. This may be due to surface changes and frequent licking or biting to “check” the area.Extension to inner lip, gums, or mouth lining
The capillary malformation may continue inside the mouth, affecting the inner lower lip, gums, or nearby mucosa. In long-standing facial port-wine stains, the teeth, gums, and jaw under the stain may slowly enlarge over time.Difficulty with lip closure or chewing in large lesions
When the lower lip becomes very bulky or asymmetric, some patients may find it harder to close the mouth fully, hold liquids in the mouth, or chew comfortably, especially if the lesion also affects the inner lip and jaw.Cosmetic concern and self-conscious feelings
Because the lower lip is very visible, even a small mark can cause embarrassment, teasing, or low self-esteem, especially in school-aged children and teenagers. Emotional distress is a real symptom and often one of the main reasons for seeking medical care.Facial or body asymmetry in CLAPO or PROS
In children with CLAPO or other PIK3CA-related overgrowth disorders, the lower lip lesion may come with one side of the face or limbs being larger than the other, or with general body overgrowth.Swelling of the face or neck from lymphatic malformations
When lymphatic malformations are also present (as in CLAPO), there may be soft swellings, fluid-filled sacs, or repeated infections in the cheek, chin, neck, or inside the mouth near the lip lesion.Rare neurological or eye symptoms in associated syndromes
If a large facial port-wine stain also involves other areas (for example upper face and eyelids), doctors may watch for seizures, headaches, eye problems, or vision loss that suggest syndromes like Sturge–Weber, even though these are uncommon in isolated lower-lip lesions.No symptom at all except the visible color change
For many people, the only sign is the colored patch. The lesion may not hurt, bleed, or cause any physical problem, but it still needs proper evaluation to rule out deeper issues and to discuss possible treatment options.
Diagnostic tests
Doctors usually diagnose a capillary malformation of the lower lip mainly by looking and feeling the lesion and asking about birth and growth history. Extra tests are used when they need to rule out deeper malformations or associated syndromes.
Physical exam tests
Full physical and skin examination
The doctor examines the whole child, not only the lip, to see if there are other birthmarks, limb size differences, or signs of syndromes like CLAPO, Sturge–Weber, or Klippel–Trénaunay. They note the size, shape, color, and exact position of the lip lesion.Close visual inspection of the lower lip
The doctor looks closely at the surface of the lip under good light. They check whether the mark is flat or raised, whether there are small nodules or blisters, and whether the color is uniform or mixed. This helps separate a capillary malformation from other conditions like hemangioma or venous malformation.Blanching test with gentle pressure
The doctor presses the lesion gently with a clear plastic slide or a finger to see whether it turns pale (blanches) and then quickly fills again. Capillary malformations often blanch partially, showing that the color is due to blood inside surface vessels.Assessment of facial and body asymmetry
The examiner looks at the face and limbs from the front and side, sometimes measuring with a tape, to see if one side is longer, wider, or thicker than the other. This helps detect overgrowth as in CLAPO or other PIK3CA-related overgrowth disorders.
Manual tests (simple hands-on checks)
Manual compression of the lip lesion
The doctor gently squeezes the lip between fingers to see how easily the lesion empties of blood and how quickly it refills. Capillary malformations usually refill quickly and are soft, while venous malformations may empty more completely and refill more slowly.Palpation for warmth, softness, or nodules
By feeling the area with the fingertips, the doctor can tell if the lesion is warm (suggesting high blood flow), soft, firm, or lumpy. Nodular or cobblestone changes suggest an older, hypertrophic port-wine stain that might need different treatment.Examination inside the mouth and on the gums
The lower lip is gently lifted, and the inner lip and gums are inspected and felt. This shows whether the malformation also involves the mucosa, teeth, or jaw and helps in planning imaging or surgery if needed.
Lab and pathological tests
Basic blood tests (complete blood count and coagulation tests)
Routine blood work is usually normal in simple capillary malformations but may be ordered before surgery or laser treatment or to rule out other conditions if there is frequent bleeding or bruising.Genetic testing for PIK3CA (for suspected CLAPO/PROS)
If the child has a lower lip capillary malformation plus overgrowth or other vascular lesions, doctors may send blood or, more often, tissue from the lesion for DNA testing to look for PIK3CA mutations that confirm CLAPO or related overgrowth syndromes.Genetic testing for GNAQ or related genes from lesion tissue
In some centers, a small biopsy or laser-treated tissue is sent for genetic analysis of GNAQ and other genes. Finding a GNAQ mutation supports the diagnosis of a capillary malformation / port-wine stain and may guide future targeted therapies.Histopathology (microscopic exam) of a lip biopsy
When the diagnosis is uncertain, a small piece of tissue may be removed and examined under the microscope. Typical findings in port-wine stains include dilated capillaries and post-capillary venules in the upper and mid dermis, sometimes deeper and thicker in nodular lesions.Immunohistochemistry to highlight vessel and lymphatic markers
Special stains such as CD31 or D2-40 can help separate pure capillary malformations from combined venous or lymphatic malformations. This matters for treatment choice, especially when surgery or sclerotherapy is considered.Extended genetic panels or exome sequencing (research or complex cases)
In very complex or syndromic cases, doctors may use broader genetic panels or exome sequencing to look for other mosaic mutations that explain the pattern of vascular and overgrowth features. This is more common in research settings.
Electrodiagnostic / functional blood-flow tests
Laser Doppler flowmetry or perfusion imaging
Laser Doppler devices shine light on the skin and measure how the reflected light changes with moving blood cells. This gives a non-invasive picture of blood flow inside the port-wine stain and can help monitor treatment response, especially to laser therapy.Photoplethysmography and other optical perfusion methods
Photoplethysmography uses light sensors to detect small changes in blood volume in the skin over the lesion and convert them into electronic signals. These methods are mostly used in research but show how active the abnormal vessels are and how they change with treatment.
Imaging tests
Color Doppler ultrasound of the lip
Ultrasound uses sound waves to show the soft tissues of the lip, while Doppler adds information about blood flow. It helps distinguish low-flow capillary malformations from high-flow arteriovenous malformations and from deep venous malformations.High-resolution ultrasound for lesion depth and borders
Detailed ultrasound can show how deep the malformed vessels go and how close they are to muscles, glands, or nerves. This is important before any surgery or aggressive laser treatment on the lip.Magnetic resonance imaging (MRI) of face and neck
MRI with contrast can map deeper vascular malformations in the soft tissues and bones around the lip, chin, and neck. It is especially useful in CLAPO and other complex malformation syndromes to guide treatment and to check for brain or eye involvement when indicated.MRI of the brain (when large facial port-wine stains are present)
If there are large facial port-wine stains extending beyond the lip, particularly around the eye or forehead, MRI of the brain may be done to look for leptomeningeal vascular malformations typical of Sturge–Weber syndrome.CT scan or 3-D imaging of the jaw and facial bones (selected cases)
In patients with marked overgrowth or asymmetry of the jaw or teeth, CT or other 3-D imaging can show how much bone is involved. This helps surgeons plan corrective procedures if needed.
Non-pharmacological treatments
1. Early specialist assessment and monitoring
A very important first step is early referral to a dermatologist or vascular-anomalies clinic to confirm that the lesion is a capillary malformation and not an infantile hemangioma, venous malformation, or tumor. The specialist will examine the lip, teeth, gums, tongue and face, and may order ultrasound or MRI if deeper involvement is suspected. Regular review helps track color changes, lip thickness, and any bleeding, and supports timely treatment decisions and family counselling.
2. Watchful waiting with education
When the lesion is small, flat, and not causing bleeding or functional problems, careful observation with good information for the family is often enough. Parents are taught what is normal (stable size, slow color change) and what is concerning (rapid enlargement, ulceration, repeated bleeding or pain). This approach avoids unnecessary procedures in very young children but still allows prompt intervention if the lesion becomes thicker, darker or symptomatic over time.
3. Pulsed dye laser (PDL) therapy
Pulsed dye laser at about 585–595 nm is considered the treatment of choice for most capillary malformations, including those on the lip. The laser targets hemoglobin in the abnormal capillaries and selectively heats and closes them while sparing most surrounding tissue (“selective photothermolysis”). Several sessions are usually required and improvements are gradual, but modern devices and protocols have a good safety profile with careful cooling and energy settings, making PDL a core non-drug therapy.
4. Other vascular lasers and light devices
In some patients, especially when lesions are thick, nodular, or PDL-resistant, dermatologic surgeons may use other lasers such as Nd:YAG, alexandrite, or intense pulsed light devices. These options penetrate deeper or use different wavelengths, which can help treat vessels that are not fully reached by PDL. Because the lower lip has delicate mucosa and rich blood supply, these treatments must be performed by experienced surgeons to minimise scarring, pigment change, or ulceration.
5. Lip and oral hygiene care
Daily gentle cleaning of the lips and mouth lowers the risk of infection around small surface cracks or laser-treated areas. Using a soft toothbrush, non-irritating toothpaste, and regular dental check-ups helps prevent gingivitis and trauma from sharp teeth edges that might cut the fragile malformation. Good oral hygiene is especially important before and after surgery or laser to support healing and avoid secondary bacterial colonisation in the treated area.
6. Moisturising and barrier protection
Because the affected lower lip can be dry, crusty, or easily cracked, frequent use of bland lip moisturisers (for example, petrolatum-based ointments) provides a protective barrier. This simple non-drug measure reduces pain, decreases minor bleeding from splits, and improves comfort during eating and speaking. Avoiding fragranced or flavored balms reduces the chance of irritation or contact dermatitis, which could worsen redness or swelling in the malformation area.
7. Avoidance of trauma and harmful habits
Children and adults with a lower-lip capillary malformation should try to avoid lip-biting, picking at crusts, or playing with sharp objects near the mouth. Parents can help by trimming fingernails, discouraging chewing on pens or toys, and using mouth guards in contact sports if needed. Reducing repeated trauma decreases episodes of bleeding, scabbing, and scar formation, which can otherwise make the lip more irregular and cosmetically distressing.
8. Camouflage makeup and skin-colored products
For school-aged children, teenagers, and adults bothered by the cosmetic appearance, medical-grade camouflage makeup or skin-colored lip products can hide some of the redness. Dermatologists or specialist nurses can teach color-matching and application techniques that are safe for sensitive skin. While cosmetic, this simple strategy often improves self-confidence, reduces social anxiety, and can be used alongside laser or surgical treatments without affecting medical outcomes.
9. Psychological and social support
Visible facial differences can lead to bullying, teasing, or low self-esteem, especially in school environments. Access to psychologists, social workers, or support groups familiar with vascular anomalies helps children and families cope with questions, comments, and appearance-related stress. Evidence from children with port-wine stains and other facial birthmarks shows that structured psychological support improves quality of life and helps families handle long-term treatment plans more positively.
10. Photographic and digital monitoring
Taking standardized photos of the lip (same light, angle, and distance) every few months allows clinicians and families to objectively see changes in color, thickness, and symmetry. This digital follow-up is especially useful when considering the timing of laser sessions or surgery, or when the capillary malformation is part of CLAPO syndrome and body overgrowth needs to be followed over years. It also helps document response to treatment for future decisions.
11. Speech and feeding therapy when function is affected
In some cases the lower lip becomes thick or asymmetric enough to slightly change articulation or difficulty keeping saliva inside the mouth. Speech and feeding therapists can evaluate how the lip moves during talking and eating and teach exercises or compensatory techniques. These non-pharmacological strategies can be used before or after surgery or laser therapy to strengthen muscles, improve lip closure, and make daily activities easier.
12. Orthodontic and dental alignment care
Abnormal tooth position, malocclusion, or sharp edges may repeatedly injure the malformation on the inner lip surface. Orthodontic assessment and, if needed, braces or smoothing of edges can reduce this chronic irritation. Optimising bite alignment also helps distribute pressure more evenly on the lip, which may reduce discomfort during chewing and speaking and lowers the risk of accidental biting episodes.
13. Protective strategies before dental or surgical procedures
Before dental work or any procedure near the lip, the treatment team should be informed about the capillary malformation. Planning may include gentle handling, local measures to control bleeding, and sometimes prophylactic sutures or pressure dressings. In extensive lesions or combined malformations, the surgical team may arrange additional tools such as electrocautery or resorbable hemostatic materials to prevent prolonged bleeding from fragile capillary beds.
14. Cool compresses for minor swelling or post-procedure care
After laser sessions or minor trauma, short periods of cool compresses wrapped in a soft cloth can decrease swelling, burning, and discomfort. Cooling causes temporary vasoconstriction (narrowing of vessels) and can reduce superficial oozing without drugs. Care must be taken not to apply ice directly on the lip, which could cause cold injury, especially in young children with delicate skin.
15. Sun and UV protection
Although the lower lip is partly sheltered, chronic sun exposure can irritate the lip, darken vascular lesions, and promote skin aging and actinic damage. Wide-brimmed hats and, in older children and adults, lip products with SPF can protect this sensitive area. For people who have had laser, avoiding sun for a few weeks and then using sun protection reduces pigment problems and supports more even cosmetic results.
16. Lifestyle measures to support vascular and skin health
General measures such as not smoking (in adolescents and adults), regular physical activity, and a balanced diet rich in fruits, vegetables, and healthy fats support overall vascular and skin health. Although these measures do not remove the capillary malformation, they can reduce general inflammation and help wound healing when procedures are needed. Lifestyle actions work together with medical therapies rather than replacing them.
17. Multidisciplinary vascular-anomalies clinic follow-up
Because capillary malformations of the lower lip can exist alone or as part of CLAPO or other PIK3CA-related overgrowth syndromes, care in a multidisciplinary clinic (dermatology, plastic surgery, interventional radiology, dentistry, genetics) provides the safest long-term plan. These teams coordinate imaging, procedures, and genetic counselling, and they are familiar with newer options such as targeted pathway inhibitors and topical sirolimus for treatment-resistant lesions.
18. Family genetic and syndrome counselling
Even though CLAPO and other PIK3CA-related overgrowth conditions are usually due to somatic (non-inherited) mutations, families often worry about recurrence and future children. Genetic counselling can explain the difference between somatic mosaic changes and inherited mutations, discuss recurrence risks, and clarify which associated features (lymphatic malformations, asymmetric growth) should be monitored over time in the child.
19. School and workplace information plans
For older children and adults, a short explanation letter from the clinician to teachers or employers can help reduce misunderstanding and stigma. The letter can state that the lower-lip lesion is a benign vascular birthmark, not contagious or due to injury, and may need occasional treatment or protection. Having this prepared information often prevents unwanted questions and supports an inclusive environment.
20. Participation in clinical research where appropriate
Some patients with extensive or treatment-resistant capillary malformations of the face and lip are eligible for research studies testing new laser parameters, topical sirolimus, or systemic targeted therapies. Participation is voluntary and requires careful discussion of risks and benefits, but it may provide access to emerging treatments while also contributing to better future care for others with similar lesions.
Drug treatments
Important: No medicine is currently FDA-approved specifically for “capillary malformation of the lower lip.” Many drugs are used off-label for related vascular anomalies or for symptoms such as pain or infection and must only be prescribed and monitored by specialists.
1. Propranolol oral solution (Hemangeol)
Hemangeol is an oral propranolol solution approved by the FDA for treating proliferating infantile hemangioma that needs systemic therapy, with weight-based doses usually given twice daily in young infants. It works as a non-selective beta-blocker that shrinks hemangiomas by narrowing blood vessels, reducing blood flow, and influencing growth signals. Its side effects include low blood sugar, slow heart rate, low blood pressure, and bronchospasm, so it is started and adjusted only under strict pediatric supervision.
2. Topical timolol maleate
Timolol eye-drop or gel solutions are FDA-approved beta-blocker medicines for glaucoma and ocular hypertension, but dermatologists often use them off-label on the skin to treat small superficial infantile hemangiomas and some vascular lesions. When applied to the lesion, timolol narrows surface vessels and may slow abnormal endothelial growth, with minimal systemic absorption if used correctly. Possible side effects, especially when used over large areas or in very young infants, include low heart rate, bronchospasm, and sleep disturbances, so dosing frequency and area must be chosen carefully.
3. Sirolimus oral solution or tablets (Rapamune and generics)
Sirolimus (rapamycin) is an mTOR-pathway inhibitor approved by the FDA for preventing kidney-transplant rejection, but growing evidence supports off-label use in complex slow-flow vascular malformations, including combined capillary-lymphatic-venous lesions that sometimes involve the lip. It works by blocking mTOR signalling, reducing abnormal vessel growth, leakage, and inflammation, which can improve pain, bleeding and quality of life. Common adverse effects include mouth ulcers, elevated cholesterol, low blood counts, and increased infection risk, so treatment requires blood-level monitoring and specialist management in experienced centers.
4. Topical sirolimus preparations
Topical sirolimus creams or gels are not yet FDA-approved, but early studies and case series for port-wine stains and other capillary malformations suggest that applying low-dose sirolimus to the skin, often combined with PDL, may enhance lightening. The drug locally inhibits abnormal endothelial and perivascular cell signalling without high systemic levels. Side effects are usually mild (local burning, irritation, acneiform eruptions), but long-term safety and optimal dosing are still being studied, so these preparations are typically used in clinical trials or under specialist protocols.
5. Intralesional bleomycin
Bleomycin is a cytotoxic antibiotic widely used intravenously for cancers; FDA labeling describes injection vials for systemic use, but very low-dose intralesional injections have been used off-label in low-flow vascular malformations of the lip to induce scarring and shrink abnormal vessels. When injected into the lesion by an experienced interventional radiologist or surgeon, bleomycin damages endothelial cells and promotes fibrosis, which can reduce bulk and bleeding. Major risks at higher cumulative doses include lung toxicity and skin ulceration, so total dose is strictly limited and reserved for select cases.
6. Local anesthetic agents (for procedures)
Medicines such as lidocaine, with or without epinephrine, are often injected or applied topically before laser or surgery to reduce pain and control bleeding in the lip. Epinephrine causes vasoconstriction, which temporarily shrinks vessels and lessens oozing during treatment. These medicines are short-acting and generally safe when dosed by weight, but overdose or intravascular injection can cause heart rhythm problems or seizures, so they must be administered by trained professionals who monitor the patient closely.
7. Paracetamol (acetaminophen)
Paracetamol is a widely used analgesic and antipyretic that helps control pain after laser treatment, surgery, or minor trauma to the lower-lip malformation without increasing bleeding risk. It works centrally to reduce pain perception and fever, but does not have strong anti-inflammatory properties or direct effects on the lesion. Overdose can cause liver injury, so clinicians and families must follow age-appropriate maximum daily doses and avoid combining multiple paracetamol-containing products.
8. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
Ibuprofen and similar NSAIDs may be used short-term to relieve procedure-related pain and mild inflammation around the lip. They block cyclo-oxygenase enzymes and reduce prostaglandin production, which decreases pain and swelling. However, NSAIDs can lengthen bleeding time and may irritate the stomach or kidneys, so many specialists prefer paracetamol for postoperative analgesia in patients with fragile vascular lesions, using NSAIDs only when benefits clearly outweigh risks.
9. Oral antibiotics (for secondary infection)
If the lip malformation becomes ulcerated or infected (for example after trauma or surgery), oral antibiotics such as amoxicillin-clavulanate or clindamycin may be prescribed according to local dental and skin infection guidelines. These drugs act by killing or stopping the growth of common oral bacteria, preventing deeper cellulitis or abscess formation. Side effects include diarrhea, allergic reactions, and, with broad-spectrum use, risk of Clostridioides difficile colitis, so they are reserved for clear signs of infection, not for routine preventive use.
10. Topical antibiotic ointments
Mupirocin or fusidic-acid ointments can be applied to small superficial fissures or post-laser crusts to reduce infection risk from skin bacteria such as Staphylococcus aureus. These agents inhibit bacterial protein synthesis locally with minimal systemic absorption. Overuse, however, can promote resistance, so topical antibiotics should be used for short courses only when the clinician suspects early infection, not as daily routine on an otherwise healthy lesion.
11. Topical corticosteroids (short-term for inflammation)
Low- to mid-potency topical corticosteroid preparations may occasionally be used for a short time if there is significant inflammatory reaction around the lesion or after procedures. They reduce local cytokine production and vascular permeability, easing redness and swelling. Prolonged or unsupervised use on the lip can cause skin thinning, telangiectasia, and rebound redness, so these creams or ointments must only be applied as directed by the treating specialist.
12. Oral antihistamines (for itching and discomfort)
Non-sedating antihistamines such as cetirizine or loratadine are sometimes prescribed if the lip becomes itchy after laser sessions or due to secondary irritation. These medicines block H1-histamine receptors, reducing itch and mild swelling. Usual side effects are mild (sleepiness, dry mouth), but they do not treat the underlying vascular malformation and should be used as short-term symptom relief rather than a long-term routine.
13. Tranexamic acid (for severe bleeding episodes – specialist only)
Tranexamic acid is an antifibrinolytic drug that reduces breakdown of blood clots and is widely used to limit surgical, trauma, and mucosal bleeding. In selected patients with severe bleeding from vascular malformations, specialists may use oral, intravenous, or topical tranexamic acid around procedures to stabilise clots and reduce blood loss. Because it slightly increases thrombotic risk in susceptible individuals, careful dosing, patient selection, and monitoring are essential, and it is never used without physician supervision.
14. Iron supplementation for chronic blood loss
If frequent lip bleeding or major surgery leads to iron-deficiency anemia, oral iron supplements may be prescribed. These provide elemental iron to support red-blood-cell production in the bone marrow, correcting fatigue, paleness, and low hemoglobin. Common side effects include constipation, stomach upset, and dark stools, so doctors adjust the dose and formulation and monitor blood counts until iron stores are restored.
15. Systemic corticosteroids (rare, specific indications)
Before the routine use of propranolol and sirolimus, systemic steroids were more commonly used for proliferating infantile hemangiomas; now they are reserved for particular complicated vascular anomalies or associated inflammatory conditions. They reduce immune activity and vascular permeability but carry significant risks such as growth suppression, weight gain, high blood sugar, and infection. Because capillary malformations of the lower lip are structural rather than inflammatory, systemic steroids are rarely used and only in carefully selected combined lesions.
16. Analgesic mouthwashes and gels
Short-acting local anesthetic gels or mouthwashes containing lidocaine or related agents may be prescribed for short periods after painful procedures or ulceration. They numb surface nerve endings and make eating and speaking more comfortable while the area heals. Overuse can cause numbness that increases biting risk, and systemic absorption is possible in children, so prescribed frequency and amount must be followed strictly.
17. Antiseptic mouthwashes
Chlorhexidine-based mouthwashes may be recommended temporarily after surgery or laser when there is a risk of plaque build-up and infection around sutures or treated surfaces inside the lip. These solutions reduce bacterial load and plaque formation on teeth and mucosa. Long-term use, however, can cause tooth staining, taste disturbance, and mucosal irritation, so they are used as a short-term adjunct to careful brushing, not as a permanent routine.
18. Systemic antibiotics for deep or spreading infection
When infection spreads beyond the lip, causing facial cellulitis, systemic symptoms, or abscess formation, broader-spectrum intravenous antibiotics may be needed in hospital. Regimens are chosen according to local guidelines to cover typical oral and skin flora, and imaging may be used to detect abscesses that need drainage. Prompt treatment helps prevent serious complications such as sepsis, cavernous sinus thrombosis, or airway compromise in extensive facial vascular malformations.
19. Targeted pathway inhibitors in trials (PI3K-AKT-mTOR axis)
Because some lower-lip capillary malformations occur in PIK3CA-related overgrowth syndromes, researchers are studying selective PI3K or AKT inhibitors for complex vascular anomalies. These medicines aim to normalise abnormal signalling in endothelial and other cells, potentially shrinking lesions and improving symptoms. At present these drugs are experimental for this indication, given only inside clinical trials or highly specialised off-label programs due to significant potential side effects and the need for close monitoring.
20. Sedation and anesthetic drugs (supportive role)
Finally, sedative and anesthetic medicines are essential partners for safe laser or surgical treatment, especially in young children who cannot stay still. These drugs do not treat the malformation directly but allow precise procedures while controlling pain and anxiety. Anesthetic plans are tailored to each patient’s age, comorbidities, and lesion size, and are handled by pediatric anesthesiologists who monitor breathing, circulation, and recovery closely.
Dietary molecular supplements
Supplements cannot remove a capillary malformation but may support general skin, wound-healing, and immune health. Always discuss doses with a clinician, especially for children or if taking other medicines.
1. Vitamin C
Vitamin C is a water-soluble antioxidant that supports collagen synthesis, capillary integrity, and wound healing. Clinical studies show that oral vitamin C after surgery or dental extraction can speed healing and reduce pain, and low vitamin C levels are linked with slower wound repair. Typical supplemental doses for adults range from 200–1000 mg/day, but long-term high doses can cause gastrointestinal upset and kidney stone risk, so therapy must be individualised.
2. Omega-3 fatty acids (EPA and DHA)
Omega-3 polyunsaturated fatty acids from fish oil or algae have anti-inflammatory effects and can influence skin barrier function and microcirculation. Human and experimental studies show that omega-3s help modulate inflammatory responses and protect skin from UV-induced damage. Typical supplemental intakes are 250–1000 mg/day of combined EPA+DHA in adults, but higher doses should be supervised because they may slightly increase bleeding tendency and interact with anticoagulant drugs.
3. Collagen peptides with micronutrients
Oral collagen peptide supplements, sometimes combined with vitamins A, C, E and zinc, have been shown in randomised trials and meta-analyses to improve skin hydration, elasticity, and dermal collagen density. Better skin quality can support postoperative cosmetic outcomes and resilience of perioral skin around the lip. Common study doses range around 2.5–10 g/day of collagen peptides, but effects are modest and best combined with overall good nutrition; side effects are generally mild gastrointestinal symptoms.
4. Curcumin (from turmeric)
Curcumin is a polyphenol with strong anti-inflammatory and antioxidant properties studied in arthritis, metabolic disease, and other inflammatory conditions. Clinical and meta-analytic data show that curcumin can reduce inflammatory markers such as C-reactive protein and may support general immune balance. Typical supplemental doses are 500–2000 mg/day in adults, often with absorption enhancers, but high or prolonged use has been linked to rare liver injury and drug interactions, so medical guidance is essential.
5. Vitamin D
Vitamin D plays an important role in immune modulation, bone health, and possibly wound healing. Many people, especially those living indoors or with darker skin, have low vitamin D levels, and correcting deficiency can support general health and infection resistance. Dose depends strongly on age, baseline level, and national guidelines; excessive intake can cause high calcium levels and kidney damage, so blood levels should be monitored when higher doses are used.
6. Zinc
Zinc is a trace element needed for collagen synthesis, immune function, and epithelial repair. Deficiency is associated with delayed wound healing and increased infection risk; replacing low zinc levels improves healing outcomes in several surgical and chronic wound settings. Supplemental doses must respect age-based upper limits because excessive zinc can cause nausea, interfere with copper absorption, and lead to anemia or immune changes.
7. Green tea extract (EGCG-rich)
Green tea polyphenols, particularly EGCG, have antioxidant and anti-inflammatory actions that may support general vascular and skin health. Experimental and clinical data suggest benefits in inflammatory skin conditions and photoprotection, though evidence is not specific to capillary malformations. Moderate supplemental doses are usually well tolerated, but concentrated extracts at high doses may affect liver function in susceptible individuals, so products should be chosen carefully and used under guidance.
8. Probiotics
Certain probiotic strains may help regulate immune responses and systemic inflammation through the gut–skin axis. Clinical studies in atopic dermatitis and other inflammatory conditions suggest that probiotics can modestly improve skin symptoms and barrier function in some patients. Because formulations and strains differ widely, and immune-compromised patients may be at risk, choice and dosing should be made with a clinician rather than self-selected for a child with a vascular malformation.
9. Resveratrol and other polyphenol blends
Resveratrol and related polyphenols from grapes, berries, and peanuts have antioxidant, anti-inflammatory, and potential vasoprotective effects in experimental and early human studies. In the context of a lip capillary malformation, their role is supportive rather than curative, possibly helping overall vascular health and oxidative stress balance. Supplements vary in strength and purity, and high doses can interact with anticoagulants, so medical advice is recommended before use.
10. Multi-nutrient “skin and wound support” formulas
Some commercial supplements combine collagen, vitamins, minerals, omega-3s and plant extracts in one product marketed for skin or wound healing. While small studies suggest modest improvements in skin parameters, they should be seen as adjuncts to, not replacements for, a balanced diet and medical care. Because ingredients and doses vary, patients and families should show the label to their clinician or pharmacist to check for overlapping components, excessive doses, or drug interactions.
Immunity booster, regenerative and stem-cell drugs
At present there are no FDA-approved stem-cell or “regenerative” drugs specifically for capillary malformation of the lower lip, and there are no medicines proven to “boost immunity” in a way that shrinks these lesions. Treatment focuses instead on laser, surgery, and – in selected complex vascular malformations – targeted pathway inhibitors such as sirolimus that actually suppress certain abnormal growth signals rather than boosting immunity. Any experimental regenerative approaches, such as cell-based therapies or tissue engineering, are currently confined to research settings and must only be used inside properly designed clinical trials at specialist centers, with full informed consent about potential risks and uncertain benefits.
Surgical procedures
1. Surgical debulking or wedge resection of the lip
When the lower lip becomes noticeably thick, heavy, or hanging due to the capillary malformation, plastic or maxillofacial surgeons may perform a partial excision (wedge resection or debulking). The goal is to remove part of the abnormal tissue while preserving lip shape, function, and nerve supply. This can improve speech, oral competence, and appearance, but must be planned carefully with knowledge of underlying vascular anatomy to minimise bleeding and scarring.
2. Combined laser and surgical contouring
In some patients, repeated PDL or other laser treatments are used first to lighten the color and reduce superficial vessels, followed later by limited surgical reshaping for residual bulk or asymmetry. This combination approach allows better control of bleeding during surgery and may achieve more natural cosmetic results. It is considered when the lesion is too thick or fibrotic for laser alone to give satisfactory flattening of the lip contour.
3. Excision of focal nodules or venous components
If the capillary malformation includes focal nodules or combined venous malformation “blebs” that bleed repeatedly, surgeons may excise these small areas under local or general anesthesia. The procedure removes the most troublesome pockets while leaving less affected tissue in place. Careful preoperative mapping and sometimes imaging help identify feeding vessels to reduce intraoperative bleeding and recurrence.
4. Sclerotherapy for associated low-flow venous components
When imaging shows that a lower-lip lesion contains significant venous malformation in addition to capillary elements, interventional radiologists may inject sclerosing agents (for example, ethanol or polidocanol) into the venous spaces under imaging guidance. The sclerosant damages the abnormal vessel wall, leading to controlled thrombosis and fibrosis that shrink the venous component and make later surgery or laser easier. Because of risks such as tissue necrosis and nerve injury, sclerotherapy must only be performed by experienced specialists.
5. Reconstruction and cosmetic revision procedures
After major debulking or in older patients with long-standing lesions, additional cosmetic surgeries such as lip reshaping, scar revision, or local flap reconstruction may be performed. These operations aim to restore a more symmetric vermillion border and natural lip contour, improving speech, eating, and self-image. Timing is individualised, often after growth has stabilised and vascular activity is lower, to reduce recurrence and achieve more durable results.
Prevention and self-care
You cannot prevent being born with a capillary malformation, but you can prevent many complications by avoiding repeated trauma, picking, or lip-biting.
Keep good oral hygiene with soft brushing and regular dental visits to reduce infection risk around the lesion.
Use gentle lip moisturisers to avoid dryness and cracking that can lead to small bleeds or infections.
Follow your specialist’s instructions about laser and surgical after-care, including cool compresses, sun protection and any short-term mouthwashes or medicines.
Avoid smoking and second-hand smoke, which harms blood vessels and wound healing.
Maintain a balanced diet rich in fruits, vegetables, and healthy fats, which supports skin, immune, and wound-healing health.
Protect the lip from excess sun exposure with hats and SPF lip products, especially after procedures.
Make sure all routine childhood vaccinations are up-to-date to reduce infection risks that could complicate surgery or healing.
Keep regular follow-up appointments with the vascular-anomalies team so that subtle changes are recognised early rather than waiting for big problems.
Seek psychological and school support if appearance-related stress, bullying, or social avoidance emerges, instead of trying to hide the problem alone.
When to see a doctor urgently or promptly
You should contact a doctor urgently (same day or emergency) if:
The lower lip suddenly swells, becomes very painful, or turns dark blue/black, which may suggest thrombosis or tissue compromise.
There is heavy bleeding that does not stop after 10–15 minutes of firm pressure with a clean cloth.
You notice fever, spreading redness, or pus, which may indicate infection or cellulitis.
Breathing, swallowing, or speaking suddenly become difficult.
You should arrange a prompt, planned visit with the vascular-anomalies or dermatology team if:
The lesion becomes thicker, darker, or more nodular over months.
There is recurrent minor bleeding, crusting, or ulceration.
Appearance changes are causing emotional distress, bullying, or withdrawal from social activities.
What to eat and what to avoid
Helpful to eat (examples):
Colorful fruits and vegetables (berries, citrus, leafy greens) provide vitamin C, antioxidants, and other nutrients that support collagen and wound healing.
Foods rich in omega-3 fats (fatty fish, flaxseed, walnuts) help modulate inflammation and support skin barrier health.
Protein-rich foods (eggs, lean meats, dairy, legumes) provide amino acids for tissue repair after laser or surgery.
Whole grains and fiber (oats, brown rice, lentils) support stable energy and gut health, which indirectly benefit immunity and healing.
Hydrating fluids (water, herbal teas) keep mucous membranes moist and help maintain healthy circulation to the lip.
Better to limit or avoid (examples):
Very hot, spicy, or acidic foods (chili, very hot soups, excess citrus) can sting or irritate the malformation and make small cracks more likely to bleed.
Hard, sharp snacks (hard candy, crusty bread edges, chips) may cut the fragile lip surface and trigger bleeding.
High-sugar drinks and snacks that promote dental caries, which can complicate oral surgery and overall oral health.
Caffeine and energy drinks in older patients, which in excess may contribute to dehydration and sometimes worsen anxiety around appearance and procedures.
Alcohol and smoking (for adults), which harm blood vessels, delay wound healing, and interact with many medicines used around surgery or laser.
Frequently asked questions (FAQs)
1. Will a capillary malformation of the lower lip go away by itself?
Unlike many infantile hemangiomas that grow and then partially involute, true capillary malformations are usually lifelong. They may darken, become thicker, or develop nodules with age, but they rarely disappear without treatment. Laser and, when needed, surgery are the main ways to reduce color and bulk.
2. How is this different from a hemangioma?
Hemangiomas are benign vascular tumors that rapidly grow then slowly shrink, and they often respond very well to propranolol. Capillary malformations are structural malformations of dilated capillaries present at birth that grow with the child and do not involute, so they need different management strategies such as PDL and, in complex cases, sirolimus or surgery.
3. Is capillary malformation of the lower lip always part of CLAPO syndrome?
No. Many people have an isolated lip capillary malformation without other problems. However, a characteristic midline lower-lip lesion can be a key sign of CLAPO syndrome, which also includes lymphatic malformations of the face/neck and body overgrowth due to PIK3CA mutations. Careful examination and sometimes imaging help decide whether a broader syndrome is present.
4. Is pulsed dye laser safe on the lip?
When performed by experienced dermatologic or plastic surgeons using appropriate parameters and cooling, PDL is considered safe and effective for many lip capillary malformations. Temporary swelling, bruising, and crusts are common, but serious scarring or pigment changes are uncommon. Multiple sessions are usually needed, and results are gradual rather than instant.
5. Can sirolimus cure a lip capillary malformation?
Sirolimus does not “cure” the malformation but can significantly reduce symptoms such as pain, bleeding, leakage, and functional problems in complex or combined vascular anomalies. It modifies abnormal vessel signalling and growth but usually needs long courses and close monitoring for side effects, and lesions may worsen again if the drug is stopped. It is reserved for selected patients in specialised centers.
6. Are there medicines that make the lesion worse?
Any medicine that strongly increases bleeding risk (for example high-dose NSAIDs or anticoagulants) can potentially make bleeding from a vascular malformation more problematic. That said, many people never need these drugs, and decisions are individualised. Always tell doctors and dentists about the lip lesion before new medicines or procedures so they can balance benefits and risks.
7. Can diet alone treat a capillary malformation?
No diet can remove or shrink the malformation, because it is a structural change in blood vessels rather than a nutritional deficiency. However, a nutrient-dense diet with enough protein, vitamins C and D, zinc, and healthy fats supports wound healing, immunity, and recovery from any procedures, so it is still an important part of overall care.
8. What is the usual age to start laser?
Many experts now start PDL in infancy or early childhood for facial capillary malformations because earlier treatment often gives better lightening with fewer sessions and less thickening. The exact timing depends on lesion size, color, and the child’s health and cooperation, and is decided together with the family after discussing risks and benefits.
9. Does treatment hurt?
Laser pulses are often described as feeling like a rubber-band snap, and the lip can sting or swell afterward. Topical or injected local anesthetic, cooling devices, and post-treatment analgesics such as paracetamol are usually enough to keep discomfort manageable. For very young or anxious children, general anesthesia may be used to perform sessions safely.
10. Can the malformation come back after treatment?
Color and thickness usually improve but may not disappear completely, and some darkening or new visible vessels can appear again over years, especially during growth or hormonal changes. Follow-up and occasional maintenance laser or additional procedures are sometimes needed, so treatment is best seen as long-term management rather than a single one-time cure.
11. Is it dangerous to leave a small capillary malformation untreated?
Many small, flat lesions that do not bleed or affect function can be safely observed with regular check-ups. The main risks of leaving them untreated are cosmetic impact and, in some cases, gradual thickening or nodularity. Decisions about when to treat are based on appearance, symptoms, family preference, and any associated syndromic features.
12. Can capillary malformations turn into cancer?
Capillary malformations themselves are benign and do not transform into cancer. However, any new hard lump, ulcer that does not heal, or very rapid change in a previously stable lesion should be assessed by a doctor to exclude other conditions that can occasionally arise in the same area.
13. Are stem-cell or gene therapies available now?
Research into gene-targeted and cell-based therapies for PIK3CA-related overgrowth and vascular anomalies is ongoing, but there are currently no approved stem-cell or gene therapies for capillary malformations of the lip. Participation in clinical trials at specialised centers is the only way to access such experimental treatments, and risks, benefits, and uncertainties must be carefully discussed.
14. Is capillary malformation of the lower lip hereditary?
Most cases, especially in CLAPO and related PIK3CA-spectrum conditions, are due to somatic mosaic mutations that arise after conception and are not inherited in a simple way. This means recurrence risk in siblings is usually low, although exact risk is still being studied; genetic counselling can provide personalised information for each family’s situation.
15. What is the long-term outlook?
With modern multidisciplinary care using laser, surgery when needed, and good psychosocial support, most people with lower-lip capillary malformations can achieve good function and significantly improved appearance. Early diagnosis, regular follow-up, and tailored treatment plans are the keys to preventing complications such as chronic bleeding, severe thickening, or major emotional impact.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 27, 2025.
