CONGENITAL VASCULAR LESIONS OF THE SKIN AND PHOTOGRAPHS OF CASES

Port-Wine Stain or True Hemangioma?
The timely and correct diagnosis of congenital vascular lesions of the skin is of utmost importance for the selection of the appropriate treatment method.

As far as congenital vascular lesion of the skins are concerned, both the timely and the correct diagnosis of either port-wine stain or a superficial true hemangioma is of utmost importance. Immediate treatment of the lesion using the appropriate treatment method is necessary during the first weeks of life.

Of course panic and indifference or devaluation of such findings are definitely not the proper initial reaction. The accurate and timely diagnosis as well as the provision of the right information constitute the right initial steps for the treatment of the condition.

The prognosis of cases that were diagnosed early and treated using the right method is excellent, while at the same time both psychological and physical problems may be avoided, as well as the economic burden both for the patient and for his/her family.

Port-Wine Stains remain stable and they do not show any improvement over time. The sooner the treatment with Pulsed Dye Laser (PDL) is applied, even better during the first weeks of life, the outcome of the treatment is definitely superior. Moreover, if treatment starts promptly, the degree of dysplasia is more limited and the sessions can be performed with the use of local anesthesia and they can be completed by the age of 2-3 years before the child goes to the nursery or school. Dysplasia is usually more extensive later in childhood and general anesthesia may be necessary.

On the other hand, the development of congenital true haemangiomas goes through three stages: the proliferation stage, the rest stage, and the involution stage. Therefore the progress of superficial true haemangiomas is very different as compared to Port Wine Stains. When they are located in an aesthetically significant area on the skin or when they prevent normal functioning, like vision, they should be treated promptly through the administration of propranolol per os in combination with the application of Pulsed-dye Laser (PDL)

 

PHOTOGRAPHS OF CASES

A case of successful timely diagnosis and treatment of a port-wine stain using Pulsed Dye Laser (PDL)

  • Date of birth: 20/9/11
  • Initial treatment session: 7/10/11
  • Baby’s age: 17 days old
  • Successful treatment after 8 therapeutic sessions
  • Maintenance treatment every six months

 

Cases_PWS

Early treatment with pulsed dye laser (PDL)

  • Waiting for supposedly ‘automatic’ recession or in order to start sessions “later in life’ is unnecessary and unfair to the child.
  • Treatment is definitely demanding, but it is also extremely beneficial for the child
  • Parents and treating physicians, pediatricians and gynecologists, should be well informed

A case of wrong diagnosis, prognosis and treatment

Port-wine stain (PWS) with misdiagnosis as a “true hemangioma”, wrong prognosis, ascertaining parents that it will show remission as times goes by and inappropriate administration of propranolol for 2 years in a big public pediatric hospical of Athens.

PWS_wrong

OTHER EXAMPLES OF CASES OF SUCCESSFUL TREATMENT OF A VASCULAR LESION

Below you can see photographs of cases of people with port-wine stains and true haemangiomas before the initiation of treatment and after the completion of the treatment.

 

PORT-WINE STAINS (PWS)

PWS_New_3

PWS_New_2

PWS_New_1

HAEMANGIOMAS

IH_New

 

REFERENCES

  1. Anderson RR, Parish JA. Selective Photothermolysis: Precise microsurgery by selective absorption of pulsed radiation. Science.1983;220:524-27.
  2. Atherton DJ. Infantile hemangiomas. Early Hum Dev. 2006; 82: 789-795.
  3. Chang, L.C., Haggstrom, A.N.Drolet, B.A.Baselga, E.Chamlin, S.L. et al, Hemangioma investigator group. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics. 2008;122:360–367.
  4. de Graaf M, Knol MJ, Totté JE, van Os-Medendorp H, Breugem CC, Pasmans SG. E-learning enables parents to assess an infantile hemangioma. J Am Acad Dermatol. 2014 May;70(5):893-8.
  5. Hon KL, Shen P, Li JJ, et al. Pediatric vascular anomalies: an overview of management. Clin Med Insights Dermatol. 2014; 7.
  6. Leaute-Labreze C, Prey S, Ezzedine K. Infantile haemangioma: part 1. Pathophysiology, epidemiology, clinical features, life cycle and associated structural abnormalities. JEADV 2011; 25:1245-53.
  7. Macfie, CC & Jeffrey, SL Diagnosis of vascular skin lesions in children: an audit and review. Pediatr Dermatol. 2008; 25:7–12.
  8. Oiso N, Kawada A. The dermoscopic features in infantile he­mangioma. Clin Pediatr. 2011; 28: 591-593.
  9. Smolinski KN, Yan AC. Hemangiomas of infancy: clinical and biological characteristics. Clinical Pediatrics 2005;44 (9):747–766.
  10. Syed SB. Vascular birthmarks: update on presentation and management. Current Paediatrics 1999;9(1):20–6.
  11. Τζερμιάς Χ. Αντιμετώπιση δερματικών αγγειακών βλαβών με εξελιγμένα laser. Ελληνική Επιθεώρηση Δερματολογίας Αφροδισιολογίας. 2013; 24:3, 165-177.

 

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