Capillary hemangioma – benign vascular tumor. It occurs in 1-2% of children. It is a node or plaque of bright red color with a superficial location, dark cherry – at a deeper one. With diascopy, the capillary hemangioma does not completely discolor. Histologically, there is proliferation of endothelial cells in the vessels of the dermis and subcutaneous tissue.
Vladimir Alexandrovich Tsepkolenko
MD, Professor, Honored Doctor of Ukraine,
President of the Ukrainian Society of Aesthetic
Medicine, General Director of the Ukrainian
Institute of Plastic Surgery
and aesthetic medicine "Virtus"
Capillary hemangioma (strawberry nevus, juvenile hemangioma)
The most intensive growth of capillary hemangioma occurs in infancy (up to 6 months – 1 year), and in many cases (up to 70%) it resolves on its own by 5-10 years. The rate and degree of regression do not depend on the size of the formation. In cases where there are no signs of regression (color change from crimson or dark red to lavender) before the age of 7-8 years, most likely, complete disappearance will not occur. Even after complete resorption, the skin at the site of the hemangioma remains slightly atrophic with a small number of telangiectasic vessels, and may differ in some pallor. Treatment is selected individually in each case. If possible, it is advisable to refuse treatment (the best cosmetic effect will be with self-resorption of the formation). Possibility of laser therapy
It occurs in 0.3-0.5% of newborns and is a congenital malformation of the vessels of the dermis, which occurs due to the expansion of capillaries. It has the appearance of a red or purple spot of irregular shape. As the child grows, the size of the formation increases. In adults, the surface of the nevus becomes bumpy, papules and nodes appear, which is associated with a gradual expansion of the vessels. A flaming nevus never resolves on its own, with the exception of one of its forms – nevus Unna.
Treatment: Traditionally used surgical methods (excision, tissue grafting, skin flaps, dermabrasion), as well as cryosurgery, radiotherapy, sclerotherapy are limited and unpredictable, associated with serious complications. Nd:YAG, copper vapor laser (CVL), dye laser (PDL) and argon laser are used for the treatment of flaming nevus.
In children under the age of 14, the stain can be completely eliminated after 6-8 treatments: the use of dye lasers with a radiation power of 5-7 J/cm2 is recommended.
The treatment technique for adult patients differs only in the use of a higher radiation energy density, which increases depending on the color of the lesion and its thickness. It is preferable to use a spot with a large diameter (7-12 mm), which allows for a deeper penetration of light. It is recommended to start with a radiation density of about 5 J/cm2 and increase it by 0.5 J/cm2 with each subsequent session (interval between sessions – 3-4 months).
Cavernous hemangioma (cavernous hemangioma, cavernoma)
Malformation of blood vessels of the skin, subcutaneous tissue or underlying soft tissues. Usually detected already in newborns and increases in size as the child grows. When pressed, it subsides slightly and turns pale, with a strong cough and scream it can increase and tighten. In some cases, a cavernous hemangioma is formed from a capillary hemangioma after a systematic or single injury.
Relative indications for surgical treatment of the tumor are slow resolution after 7 years, recurrent ulceration, and secondary infection. After surgical treatment of cavernous hemangioma, residual skin manifestations are often observed, which are possible even with its spontaneous resolution. Laser therapy is used for correction: PDL (575-600 nm), KTP laser (532 nm).
Teleangiectatic granuloma (pyogenic granuloma, botryomycoma)
Pyogenic granuloma (PG) – it is an acquired red or brown-red pedunculated vascular formation; contains a large number of newly formed vessels, bleeds easily when injured. PG can appear unexpectedly and rapidly increase in size, the causative agents of the disease are pyococci, mainly staphylococci. Recommended treatment: laser destruction, surgery.
CO2 laser has shown its effectiveness in PG processing. In the process of laser exposure, coagulation of all branches of vascular damage occurs, it acquires a dusty gray color. The procedure is repeated (if necessary) at intervals of 3-4 weeks.
The formation often responds poorly to treatment with pulsed vascular lasers. Improvement is often seen, but in most cases the lesion is too thick for the laser light to penetrate through its entire thickness in one procedure. It is reported that compression of superficial dilated vessels with a glass slide, which reduces the thickness of the surface layer of the skin, allows light to reach the deepest components of the mass. Processing is carried out with multiple pulses (6-10 J/cm2) until the color of the formation changes to dark purple. In the treatment, the technique of selective photothermolysis is not used, therefore, pulsed lasers do not have a qualitative advantage over continuous lasers. In the case of formations with a large depth of invasion, preliminary excision of the papular component (if a histological sample is needed) or CO2 laser vaporization is possible.
A benign, dark blue or purple vascular tumor found in older people over 50 on the face, lips, or ears. Well removed with vascular lasers. Successive pulses, with or without diascopy, must be applied for maximum efficiency, resulting in epidermal or perivascular thermal injury. A continuous dye laser (577 nm, 1 W) has also been reported to produce excellent cosmetic results. Long-pulse Nd:YAG and Nd:YVO4 lasers (frequency doubling mode, 532 nm) have also been successfully used to treat this type of vascular formation. It is recommended to use a sufficiently large spot (about 50 ms in diameter with an energy density of 100-125 J/cm2 (Fig. 2.5-16).
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