Skin Angioma

Dermatological pathology - skin angioma - is a localized vascular anomaly in the form of tumor-like growths of deformed capillaries or venules located in the dermis and subcutaneous tissue. These formations can be either protruding above the surface of the skin, or completely flat, often called birthmarks.

Angiomas are one of the most common skin defects. Code on the ICD 10 - class XII (diseases of the skin and subcutaneous tissue), L98.

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Causes of angioma of the skin

For today in dermatology it is accepted to allocate such forms of an angioma of a skin:

• red mole or angioma (cherry angioma, Campbell de Morgan spots);
• wine birthmarks or spots of port wine (or nevus flammeus, that is, a nevus flaming);
• formation of blue and purple or venous lakes;
• spider-like angioma (arachnoid nevus);
• cavernous or cavernous (cavity) angiomas - vascular tumors in the subcutaneous tissue.

Pathogenesis is defined as a congenital defect in the vessels of the skin and subcutaneous tissue. This defect, according to statistics of foreign experts, is available in 0.7-1.8% of newborns and in 10-15% of premature infants and infants with initial low weight.

Some dermatologists associate the causes of skin angiomy with the degenerative changes of collagen fibers surrounding these blood vessels, which deprives them of the necessary structural support and leads to dilatation (i.e., enlargement). Another point of view on the pathogenesis of angiomas: the proliferation of blood vessels in the skin is due to the proliferation of endothelial cells lining the inner walls of the vessels. The appearance of wine birthmarks - diffuse capillary skin lesions - is considered the result of a violation of the local innervation of the capillary network. However, all these pathological processes have genetic causes. Although skin angiomas in the form of small cherry or red moles (Campbell de Morgan spots) appear in people after 30-40 years (increasing in size and quantity), and after 60 (senile angioma or hemangioma).

Until now, there is no unified classification of skin angiomas and there is obvious terminological disagreement, which introduces a lot of confusion in describing and diagnosing these anomalies. Angiomas of the skin - as a kind of congenital vascular pathologies, have a number of names: vascular malformations (skin defects), capillary angiodysplasia, hemangiomas (which may not be congenital and occur at any age), vascular nevi (although nevi are associated with the production of skin pigment melanin ).

Specialists of the American National Skin Care Institute distinguish congenital vascular defects depending on the type of vessels involved: CM (capillary malformation), VM (venous), CVM (capillary-venous), CLM (capillary-lymphatic), LVM (lymphatic-venous), CLVM (capillary-venous-lymphatic malformation), etc.

Complications of angioma of the skin can occur with traumatic effects on them, which is fraught with bleeding. Also, the possibility of capillary microthrombi formation and the development of inflammation in the form of a purulent granuloma is not ruled out. In addition, it should be noted that so-called large-scale port stains located on the face can be with vascular tumors of the soft shell of the brain and testify to the severe congenital pathology of the Sturge-Weber-Krabbe syndrome (total CNS damage with physical and mental development disorder ).

Skin angiomas do not threaten oncology, and their prognosis is favorable in the majority of patients. However, in very rare cases, angiosarcoma of the skin or malignant hemangiendothelioma is possible .

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Symptoms of angioma of the skin

The first signs of the presence of angiomas on the skin of various parts of the body in the form of a nodule of a cherry or red mole are detected visually at the time of the birth of the child or in the adult. They can be flat or hemispherical, do not disappear when pressed, do not cause anxiety and cause no sensation.

It is also easy to recognize the wine birthmark (the kind of capillary malformation): it is already present in the newborn; never rises above the skin; has all the shades of red and pink, a variety of sizes and shapes (with fuzzy boundaries); localized on the face or head. And these spots can grow with the growth of children and acquire a rich purple color. They account for more than 10% of vascular malformations.

Diffuse capillary skin angiomas with a salmon color (yellow-pink) and called "stork markings" are located in babies on the scalp, neck, forehead or eyelids. Over time, they regress and disappear by themselves.

Symptoms of angioma of the skin in the form of a venous lake (a type of venous malformation) are tumorous papules of various forms of bluish, red or purple color with localization on the lips or eyelids (in children); in the elderly (65 years and older) they appear on the ears and are more common in men.

The spider-like skin angioma (with the red papule located in the center and the visible capillaries that diverge in different directions) is often determined by dermatologists as a stellate, vascular spider or telangiectasia angioma. They account for up to 40% of all vascular malformations. This angioma is localized in the course of the superior vena cava on the face, neck, hands and hands, on the upper chest of 10-15% of healthy adults and children. The spider-like angioma is prone to regression: it can gradually decrease in size, grow pale, and eventually disappear completely and appear only in the cold or at elevated body temperature.

Such "spiders" can appear in pregnant women, as well as in women who use hormonal contraceptives, which may be associated with an elevated level of estrogen. As experts note, the presence of more than three spider-like angiomas on the skin can be a sign of liver pathology (one-third of patients with cirrhosis have similar "marks" on the skin), and also indicates a probability of varicose veins of the esophagus.

Symptoms of angioma of the skin of a cavernous nature, which are often called hemangiomas, are the presence of a bluish or crimson node in the epidermis, which has an uneven surface; when probed, the formation is hotter, and when pressed it becomes paler. Has a tendency to increase.

The cavernous-type angiomas include a congenital red birthmark, called a "strawberry" nevus or nevus vascularis. The first signs may appear a few weeks after the birth of the child in the form of a red stain (on the face, head, back and chest). Education is growing rapidly (sometimes up to several centimeters) to about one-year-old age, and at this stage has the appearance of a bright red tumor. Then growth stops, and after about a year, a slow regress begins with a change in color to a bluish gray. In 50% of cases, such a birthmark disappears by 5 years, in 90% to 9; in its place, the formation of a whitish scar is possible. But the strawberry nevus of large size has negative consequences in the form of increased platelets in the blood, which can lead to heart failure.

Diagnosis of angioma of the skin

Angioma of the skin, as a rule, is diagnosed during the examination of the patient by a dermatologist, including using a dermatoscope. And for most pathologies of this type of skin, there is no need for clinical trials. So, as a rule, analyzes are not required.

However, when a pathological change in the underlying tissues is detected, instrumental diagnosis of ultrasound scanning (ultrasound) of vascular formation is necessary.

In more complex cases, when the color and size of the birthmark or birthmark are not typical for a particular type of angioma, a complete examination with the delivery of all analyzes is performed with bleeding of the formation. If the diagnosis is uncertain (for example, if there is suspicion of nodal melanoma or basal carcinoma), differential diagnosis is performed using biopsy and histological examination of the tissue of education, angiography, computed tomography (CT) or magnetic resonance imaging (MRI).

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Treatment of angioma of the skin

Dermatological angioma in most clinical cases does not need treatment; Moreover, with the antenatally determined nature of the pathology, treatment of angiomy of the skin is very problematic. A typical case involves diagnosing, explaining to the patient (or parents of children with different birthmarks), the causes and clinical characteristics of vascular education and the subsequent monitoring of his condition.

Surgical treatment of angiomas of the skin is carried out if the patient is concerned about his appearance, education causes discomfort or is in an area that is easily touched, which can lead to bleeding. Such treatment consists in their removal by means of:

• a pulse laser (PDL);
• cauterization by high-frequency electric current (diathermocoagulation or electrocautery);
• fulguration (non-contact plasma cauterization);
• cryodestruction (freezing of the protruding nodular angioma with liquid nitrogen);
• puncture and the introduction of sclerosing substances (alcohol);
• surgical excision.

For medicinal therapy of cutaneous angiomas, drugs such as:

• systemic corticosteroids (injections of prednisolone, hydrocortisone, etc. Into the lesion site contribute to arrest of growth and accelerated regression of angioma);
• interferon α-2a or α-2b (intramuscular injection reduces the proliferation of skin angioma);
• preparations inhibiting angiogenesis block the vascular endothelial growth factor (VEGF), are used in pathological neovascularization.

Dermatologists categorically do not recommend self-medication of congenital skin pathologies and, especially, "test" alternative treatment of skin angioma in children.

No tests and clinical trials of herbal therapy, recommended for getting rid of birthmarks, did not pass, so you do not need to smear a red mole, nevus vascularis with celandine juice or aloe, and the wine birthmark with a sage of wormwood. Hardly here will help the ash of birch firewood or a mixture of apple cider vinegar with honey and black pepper.

Tea tree oil, which is quite effective in fungal skin and nail lesions, is also powerless. In addition, it can cause an allergic reaction.

Angioma of the skin can have different localization and often causes some discomfort in a cosmetic way. But on the general state of health this is not reflected in any way, and prevention of this pathology is impossible, since there are no ways to prevent its occurrence. Go to the doctor, show your child's specialist and adhere to medical recommendations.