The International Society for the Study of Vascular Anomalies (ISSVA) published a widely accepted standard for classifying vascular anomalies updated in 2014. Lesions are broadly grouped as either vascular tumors, characterized by a proliferation of blood vessels, or vascular malformations, characterized by vessels with abnormal structure.
Hemangioma, a type of vascular tumor, and PWS, a type of vascular malformation, are the most common vascular anomalies for laser treatment. Of note, specific rare lesions seem to defy precise classification under these terms and have
been listed in a provisional category.
Why Do Skin Red Spots Require Treatment?
Patients with various vascular lesions present to dermatologists for treatment, primarily due to cosmetic concerns. However, disfiguring birthmarks can cause severe psychological disability for both patients and their families.
Pain may be present, and complications include ulceration, infection, and bleeding. Functional impairment of the sensory organs like the nose, ear, or eyes can occur with hemangiomas or port-wine stains. Serious medical problems like high-output cardiac failure and generalized bleeding may accompany large, multiple hemangiomas and visceral involvement.
What Treatment Options To Treat Skin Red Spots?
Removal of red spots r skin lesions without scarring was unthinkable a few decades ago. In the past twenty years, advances in laser technology have revolutionized the treatment of red spots or vascular disorders and expanded the dermatologist’s therapeutic armamentarium. Based on thousands of treatment sessions and follow-up evaluations,
I can safely and effectively treat these red spots (vascular) lesions in infancy, early childhood, or adults with minimal pain, textural changes, pigment changes or scarring, and minimal postoperative wound care. The laser is simply a unique light source.
When perfect parameters are used, laser light behaves like magic bullets, clearing the thousands of superficial, superficial cutaneous blood vessels without adverse effects on the surrounding tissue. This allows laser surgeons to target visible cutaneous blood vessels and invisible superficial dilated dermal capillaries.
Lasers differ in colors (wavelength) and the amount and time the laser energy is delivered to the skin. Non-selective lasers can destroy unwanted blood vessels but, at the same time, can destroy surrounding normal skin. In simple terms, lasers work precisely as a cautery machine applied to the skin with the same possibilities of scarring and pigment changes.
Improved current understanding of the effects of laser and tissue interaction has led to the design of new generation laser systems (selective vascular lasers) that deliver the right color in the right amount at the right time, allowing for extreme precision in destroying unwanted blood vessels, and at the same time providing a high safety profile.
Selective lasers (yellow, red, and infra-red) offer adjustable laser parameters that help the surgeon determine the perfect wavelength, pulse duration, spot size, and cooling time for each patient. Over the years, laser treatment has become safer and virtually painless. It is now the standard treatment for various cutaneous vascular lesions in patients from six months to six months.
How do MSI Treat Patients Suffering from Skin Red Spots?
The MSI team of medical professionals will thoroughly assess your condition before determining which laser(s) is best to treat your condition. We use selective lasers to remove vascular lesions, and occasionally we mix and match selective lasers or different laser parameters, enabling us to give the best possible results. We are proud to have the most advanced laser technology around.
Oxyhemoglobin and reduced hemoglobin have comprehensive absorption characteristics, with relevant peaks in the near-IR range (700-1200 nm). MSI we have the latest Lasers in the red and near-IR range used to treat vascular lesions, including the diode (810nm) and short and long-pulsed Nd: YAG (1064 nm).
These wavelengths have been used successfully in treating reticular veins, mature port-wine stains, and bulky vascular malformations, which tend to be challenging to treat because of large deep vessels containing deoxygenated hemoglobin.
While we use the green 532nm KTP for treating superficial vascular lesions, the fractional CO2laser is used successfully to treat nodules and hypertrophy in PWS lesions in combination. Furthermore, Elo’s technology which combines IPL and bipolar radiofrequency, offers a promising alternative.
Red Spots of Port-wine Stains:
PWSs are vascular malformations composed of ectatic capillaries and postcapillary venules in the superficial vascular plexus. PWS vessels are characterized by the diminished vascular tone and decreased density of nerves, especially those with autonomic function. In most cases, PWSs are congenital, although They may acquire in rare cases. PWSs are found in approximately 0.3% of newborns.
PWSs persist throughout life, and many thicken with time). They tend to occur on the head and neck but may appear anywhere on the body. The mean age of hypertrophy has been reported as 37 years, and by the fifth decade, approximately 65% of lesions may become hypertrophied or nodular.
There may be associated soft tissue overgrowth, leading to functional impairment in such areas as the lip or eyelid. Vascular blebs often form and may bleed with minimal trauma. These lesions are often considered disfiguring, prompting many patients to seek treatment. PWS vessels vary from 7 to 300 μm, with older patients having larger vessels.
PWSs can be associated with various syndromes.
Sturge-Weber syndrome involves a facial PWS and may have associated eye and neurologic abnormalities, including glaucoma, seizures, and developmental delay. Traditionally this was mainly attributed to PWS in the ophthalmic distribution of the trigeminal nerve.
Another syndrome, Klippel-Trénaunay, involves PWSs on an extremity associated with limb hypertrophy and lymphatic, Usually unilateral. They frequently occur on the face but also appear elsewhere. They represent a congenital birthmark occurring in 0.3 to 0.5% of newborns. They may be a few millimeters in diameter or may cover an entire limb. However, the size remains stable throughout life.
Although port-wine stains are flat and faint, they are uniform in color at birth but evolve into thick, irregularly surfaced (blebs) and deeply colored lesions by the fifth decade. Initial treatment will achieve the best results with fewer laser treatments.
Factors such as the anatomical location, color of the lesion, skin type, and patient’s age are essential in determining the degree of the clearing. Dramatic changes occur in the first six sessions. Although it is common to have less than 100% clearing after five sessions, more treatment can lead to more clearing malformations.
PWSs can also be associated with arteriovenous malformations in capillary malformation syndrome.
Red Spots of Salmon patches (stork bite, angel’s kiss)
Aree variants of nevus flammeus; are present in 40% to 70% of newborns. They are red, irregular, macular patches resulting from the dilation of dermal capillaries. The most common site is on the nape, where the lesion is referred to as a stork bite. Salmon patches on the face fade within a year, but those on the nape may persist for life. Treated the same as above if needed
Red Spots of Infantile Hemangiomas:
Infantile hemangiomas are benign endothelial cell proliferation, representing the most common infancy tumor, occurring in 4% to 10% of infants. Female gender is a notable association, with lesions arising three times as often in female infants. Other risk factors include prematurity, multiple gestations, advanced maternal age, and family history of hemangiomas.
The typical presentation is within the first few weeks of age as a whitish, red, or telangiectatic macule, with 60% on the head and neck.
The proliferative period typically lasts until 6 to 8 months for superficial hemangiomas, although deep hemangiomas may proliferate longer. Involution then occurs more slowly over the years. An often-cited estimation is that approximately 10% of hemangiomas are expected to regress with each year of age, with the vast majority having regressed by age 10. However, studies suggest this process may occur sooner.
After the regression, many hemangiomas leave behind residual fibrofatty tissue, atrophy, or telangiectasia. Hemangiomas typically do not require imaging studies. Multiple hemangiomas, usually greater than five, or hemangiomas in specific locations, may prompt radiologic investigation to assess possible associated syndromes or visceral involvement.
Red Spots of Pyogenic granuloma are acquired vascular lesions, usually solitary, 0.5-2.0 cm in diameter, bright red, and pedunculated. These lesions typically occur as a superimposed growth on the surface of a PWS. The surface is soft, bleeding easily with trauma. It may become ulcerated and develop a granulomatous surface with a brown or black crust. Lesions usually appear suddenly and may enlarge rapidly. The pyogenic granuloma may clear after 1-3 laser treatments.
Red Spots of venous lakes are dilated lake-like venules in the upper dermis commonly seen on the lips or ears of elderly patients. These lesions are dark blue to purple, soft, raised nodules, usually 2- 10 mm in diameter. Patients request treatment because of concern over possible medical consequences, recurrent bleeding with trauma, or cosmetic improvement.
Red Spots of Angiokeratomas are characterized by ectatic superficial dermal vessels and overlying hyperkeratosis. Lesions are often solitary. Less common variants include multiple angiokeratomas, characteristically found on the lower extremities, angiokeratoma of Fordyce in the genital region, angiokeratoma of Mibelli on the dorsal hands, and feet, and angiokeratoma circumscriptum. Lesions may also be associated with Fabry disease, an X-linked recessive disorder characterized by < UNK>- galactosidase A deficiency of α-galactosidase A.
Red Spots of Telangiectasia: Telangiectasia refers to superficial cutaneous vessels visible to the human eye. It may be linear, arborizing, spider, or papular. Vessels measure 0.1-1.0mm in diameter and represent a dilated venule, capillary, or arteriole. Red linear and arborizing telangiectasias are standard on the face, especially on the nose, mid cheeks, and chin.
Blue linear and arborizing telangiectasias are most seen on the legs and may be found on the face. These lesions are also seen relatively frequently on the legs. Spider telangiectasias typically appear in preschool and school-age children. All forms of telangiectasia are thought to occur through the release or activation of vasoactive substances under the influence of numerous factors, such as anoxia, hormones, or chemicals. At MSI, Selective lasers (yellow, red, infrared) are used to safely and effectively clear telangiectatic vessels up to several millimeters in diameter. It is common to do sclerotherapy with legs to clear “feeding” leg vessels before laser surgery.
Red Spots of cherry angiomas are small, well-circumscribed, bright-red vascular proliferations that initially appear in early adulthood and increase in number with age. These benign growths can be easily treated with cryosurgery, radiofrequency, and vascular-specific lasers to improve cosmesis.
Red Spots poikiloderma of Civatte clinically appears as a reticulated brown pigmentation of the neck, anterior chest, and lower face with prominent telangiectasias caused by chronic sun exposure. The ectatic vessels in the papillary dermis are usually 0.1 mm in diameter. Poikiloderma treatment using selective thermolysis requires wavelengths absorbed concurrently by melanin and hemoglobin. The intense pulsed light (IPL)has successfully treated this condition. The intense pulsed light source may prove more helpful in eliminating associated hyperpigmentation because of its additional effect on epidermal melanin.
Lymphangiomas are slow-growing lymphatic malformations acquired after lymphatic drainage obstruction, chronic inflammation, infections, trauma, or surgical procedures. However, most are congenital and arise from abnormal budding of lymphatic structures, failure of venous vasculature to unite with the lymphatics, and atypical lymphatic tissue sequestration during embryogenic development.
Most of these lesions are diagnosed at age 2years, with half diagnosed at birth. Lymphangiomas are typically found as soft tissue masses in the axillae or neck regions, but they can occur in other locations such as the tongue, esophagus, and upper airways.
Lymphangiomas can be found in patients with specific chromosomal abnormalities, such as Turner syndrome. These lesions can be classified as either superficial or deep. A superficial lesion is the lymphangioma circumscriptum, whereas cystic hygroma is a deep lymphatic malformation typically found in the neck.
A lymphangioma may not require treatment; 15% of cystic hygromas may spontaneously regress. Surgical excision is typically the preferred treatment modality; however, complete excision may not always be possible because of vital structures’ location and involvement.
Other options include sclerosing agents and laser therapy. Successful treatment with lasers (i.e., Nd: YAG, PDL, carbon dioxide) has been reported. They have been used for ablation, debulking, and complete excision. Successful treatment for lymphangiomas, especially those in the oral cavity, has been reported using Nd: YAG lasers. However, scarring after laser treatment, recurrence, and multiple treatment sessions should be of concern.
Carbon dioxide lasers work by vaporizing the tissues (non-selectively) and sealing the lymphatic channels. The main disadvantage of this treatment modality is the need for local or general anesthesia and subsequent scarring. PDL has been used to treat vascular abnormalities, but it is not the choice treatment for lymphangiomas due to the laser’s selectivity and superficial absorption.
Red Spots of acne Rosacea
Rosacea commonly presents in association with chronic photodamage with background facial erythema and telangiectasia, defined as superficial vessels 0.1 to 1 mm in diameter. Telangiectasias may also be seen in various conditions, including connective tissue diseases, various genodermatoses, and hereditary hemorrhagic telangiectasia. Laser treatment of telangiectasias
and facial erythema can improve the appearance of many patients, but again, recurrence is not uncommon
Red Hypertrophic/Atrophic Scars:
Prof Moawad strongly believes in using non-ablative lasers targeting micro-vascular and the non-ablative acne-specific laser long-pulsed 1320nm Nd: YAG that MSI uniquely owns is the first step in an integrated program to improve acne scars, especially in darkly pigmented skin. It results from skin-repairing wounds caused by trauma, surgery, or a skin disease like acne.
The more severe the damage, the longer it takes for the skin to heal, and the greater the chance of noticeable scars. When selective lasers are used as early as possible, there is an improvement in the itchiness, redness, and skin surface texture. The scar height is reduced, and the overall scar appearance approaches those of normal surrounding skin.
Red Spot of Stretch Marks:
Dermal scars with overlying epidermal changes. Mechanical stress and hormonal changes are the principal factors that trigger most stretch marks, occurring most in healthy adult women, most often during pregnancy, or with excessive weight gain. Sometimes they appear after a chronic illness or excessive use of topical steroids. Whatever the cause, destruction of the elastin and collagen is the result.
Clinically, striae first appear as flattened, thinned skin with a pinkish hue and occasionally itchy. The lesions pass through an early phase of inflammation (striae rubra) when they enlarge in length and width and take on a vivid reddish-purplish color. Over time, they assume a white, sunken appearance (striae alba) parallel to skin tension lines. Stretch marks occur most frequently in areas of mechanical stress such as breasts, abdomen, thighs, groin, or buttocks.
Adopting a combination approach at MSI that includes topical cosmeceuticals, diamond peel, non-ablative vascular, and water targeted lasers as well IPL and fractional CO2 laser have led to a successful outcome in treating both red and white striae.
Are caused by a viral infection of the cells found in the top layer of the skin. One or more members of the human papillomavirus (60 viruses) cause them. Each of the HPV types is associated with a different type of wart. Different warts include standard hands, feet, flat, and genital warts. Warts commonly occur in children and young adults but may appear at any age.
Their course is highly variable. Most resolve spontaneously in weeks or months; others may last years or a lifetime. Warts are transmitted simply by touch. And commonly appear at sites of trauma, on the hands, in peri-ungual regions from nail-biting, and on plantar surfaces.
Warts are skin-colored and feel rough to the touch. Histologically there are prominent, dilated blood vessels in dermal papillae that are thought to provide nutrients to infected epidermal cells. Although commonly more of cosmetic or nuisance significance, warts can be painful and even disabling in sub-ungular or plantar locations.
Recent evidence showed that selective destruction of prominent blood vessels in warts using a specific vascular laser would prevent virus-infected cells’ nutritional blood and growth. The red and infra-red long pulse is used on all warts, including recalcitrant warts.
Lesions appear gray to purpuric becoming black after twenty-four hours. Patients treat everyone for two weeks until resolution. Efficacy of the treatment and ease and lack of pain or scarring make laser a superior tool in fighting recalcitrant warts than other traditional modalities.
The ability to operate in a bloodless field offers well-documented advantages. Wart regression after vascular laser surgery results from vascular-specific injury inflicted on their prominent dermal blood supply thought to provide nutrients to infected epidermal cells. Over the past few years, the carbon dioxide laser (CO2) has become a standard modality in treating warts, particularly in those lesions that have proven recalcitrant to other traditional therapies.
- Vascular lesions are one of the most common indications for laser treatment.
- Pulsed dye laser remains the standard gold treatment for port-wine stains, and while most improve, the minority clear entirely.
- Early laser treatment improves port-wine stain response
- Indications for laser treatment of hemangiomas include ulcerated lesions and involuted lesions with residual telangiectasias and textural change
- The role of laser treatment for proliferating hemangiomas remains less clear and may be most beneficial for superficial hemangiomas
- I may implement Deeper-penetrating near-infrared lasers to treat select venous malformations
- Vascular lasers and intense pulsed light are the treatment of choice for the background erythema and telangiectasias associated with rosacea
- Poikiloderma of Civatte can be successfully treated with intense pulsed light, or a combination of vascular and pigment selective lasers