13.6 Vascular Lesions

What causes Hemangiomas?

benign proliferation of blood vessels in the dermis

Port-Wine Stain (Nevus Flammeus)

• large, flat, macular patch over scalp or face

• dark red, bluish, or purplish

• along CN V

• presents at birth, usually doesn’t fade

“Strawberry Mark” (Infantile Hemgioma)

• plump, bright red, well-defined borders

• benign growth of endothelial cells (2-3 cm diameter)

• does not blanch with pressure

• presents in neonatal period, involute/shrink by age 3, disappears by age 5-7

What is the most frequent complication?

ulceration (treated with oral nonselective beta-blocker medication)

Deep Hemangioma (Mature)

• reddish-blue, irregular shape, solid & spongy mass of blood vessels

• does not involute/shrink spontaneously

• most don’t require medication

• may present at birth, can enlarge during first 10-15 months

Telangiectasia

• caused by permanently enlarged, dilated blood vessels

• visible on skin surface

• Tx: may use cosmetic or laser & specialized injection sclerotherapy

Spider Telangiectasia

• fiery red, star-shaped, solid circular center

• capillary radiations

• note central pulsating body & blanching of extended legs

Where does spider telangiectasia develop?

• face, neck, or chest (upper)

• may associate with pregnancy, chronic liver disease, or estrogen therapy or normal

Venous Lake

• blue-purple dilation of venules & capillaries

• star-shaped, linear, or flaring pattern

• pressure can make them empty or disappear

• Tx: electrosurgery or laser

Where does venous lake develop?

lips, ears, aging adults face

What causes Purpuric Lesions?

blood flowing out of breaks in vessels, RBCs are deposite in tissues (extravascular)

Petechiae

• tiny hemorrhages (1-3 mm)

• dark red, purple, brown

• may indicate abnormal clotting factors (septicemias)

What causes petechiae?

bleeding from superficial capillaries, won’t blanch

Where are areas of lighter pigementation in dark-skinned people?

abdomen, buttocks, volar/anterior forearm

Ecchymosis

• purple patch (>3 mm diameter)

Purpura

• confluent/overlapping extensive patch of petechiae & ecchymosis (>3 mm diameter)

What age group are at higher risk of pupura lesions?

aging adults due to their thin, fragile skin that is sensitive to minor trauma → blood leaks from capillaries

Contusion (Bruise)

• mechanical injury (blow)

• intact skin

• can also result from bleeding disorder & liver dysfunction

Progression of bruise colors

• red-blue → purple → blue-green → yellow → brown to disappearing

• recent bruise in dark-skinned=dark purple

Purpura v.s Bruise

purpura is not caused by blunt force trauma

What can’t you do with bruise color

you can’t date the age of the bruise