Vascular anomalies and wounds

Vascular anomalies comprise vascular tumours and vascular malformations. Some vascular anomalies result in ulcerations and necrosis. In vascular tumours, infantile haemangiomas are predominant and ulceration is demonstrated in up to 16%. In vascular malformations, arteriovenous malformations predominate and frequently demonstrate either primary ulceration or skin necrosis after diagnostic and therapeutic procedures. Various diagnostic and therapeutic imaging methods, such as X-ray, computed tomography (CT), magnetic resonance imaging (MRI), duplex Doppler ultrasound, and angiography, are used to visualize vascular anomalies; angiograms are required when embolization is attempted and blood flow needs to be further investigated. Duplex Doppler ultrasound is useful for routine check-ups as a therapeutic tool; however, it has limited in precision and accuracy. The aim of the present review is to give an overview of wounds related to vascular anomalies, detailing the diagnostic imaging and treatment options.     

[Artículo traducido] Malformaciones vasculares: un enfoque histopatológico y conceptual

In the field of vascular anomalies, distinguishing between vascular malformations and tumors has become crucial for a correct therapeutic approach. However, the differential diagnosis between these two groups is not always well explained in classical texts, mainly because many vascular malformations are still known with old names that suggest a tumoral nature. Also, genetic and pathogenic knowledge of these entities has greatly increased in recent decades, so researchers and clinicians now have a better understanding of vascular malformations. In this paper, we present the main histopathological tips to recognize and identify a vascular malformation as such. We also contextualize such information in the clinical and pathogenic knowledge for a better understanding of these entities.     

Telangiectasia macularis eruptiva perstans: diagnóstico dermatoscópico

IntroductionTelangiectasia macularis eruptiva perstans (TMEP) is a rare cutaneous mastocytosis, characterised by erythematous and/or brown macula in which telangiectasia are identified. The diagnosis is based on the clinical state of the lesions and on histopathology; however dermoscopy is an important diagnostic tool, revealing a very characteristic reticular vascular pattern.MethodologyA clinical examination, dermatoscopy, photographic follow-up, and histological study were performed on 5 patients with erythematous brown spots on the neck and V of the neckline, and were seen in this Centre between 2008 and 2018. A polarised light dermatoscope was used on lesion and the skin around it. All patients had a 4 mm punch biopsy of the affected skin, and the slices were stained with haematoxylin-eosin and Giemsa.ResultsThe dermatoscopy of the 5 patients showed a retiform vascular pattern with surrounding and crossing yellow spots corresponding to the follicular sebaceous glands, with few hairs. The skin around the lesion did not show any of these changes. In all patients, biopsy with haematoxylin-eosin corroborated the diagnosis of mastocytosis type TMEP. The location of the disease in the 5 patients was in the neck and V of the neckline.ConclusionsDermatoscopy helps in the diagnosis of TMEP by demonstrating that the retiform telangiectatic vascular pattern is a constant finding in all affected patients, and this is supported by the dermoscopic-histological findings. It also makes it possible to differentiate with other erythematous skin disease, and with other disorders that dermatoscopically exhibit retiform patterns.     

Targetoid hemosiderotic hemangioma - Case report

Targetoid Hemosiderotic Hemangioma, also known as Hobnail Hemangioma, is a lesion of vascular origin, probably lymphatic. The most common clinical feature is a solitary violaceous papule surrounded by a pale, thin area and a peripheral ecchymotic ring, simulating a target. Histopathologically, there is a biphasic pattern, with dilated vessels in the superficial dermis and pseudoangiosarcomatous pattern in the deep dermis, and endothelial cells with hobnail morphology. A simple excision is curative. We report a rare case of Targetoid Hemosiderotic Hemangioma.     

In support of the delayed response of naevus of Ota to a Nd‐YAG laser patch test

Unilateral naevoid telangiectatic syndrome (UNTS) was first described in 1899 and is characterized by the dermatomal distribution of telangiectasia. It is broadly divided into congenital and acquired forms based upon the time of presentation. To date no effective treatment has been reported for this condition. In view of the vascular component of this eruption, it was felt that the pulsed dye laser (PDL), 585 nm, may have a role to play in the selective photothermolysis of these lesions. The treatment of five patients with acquired UNTS using the PDL is described. Based upon the findings it is concluded that the PDL is an effective treatment for UNTS; however, the clinical response is short lived with a 100% recurrence noted in all cases. Possible explanations for this condition are also briefly discussed.     

Atenolol oral en el manejo del hemangioma infantil: serie de casos de 46 pacientes

Propranolol, a non-selective beta-blocker, remains the first line of treatment for problematic infantile hemangioma. However, although rarely, a subset of patients experience undesirable side effects, raising interest in other selective beta-blockers. We present a large case series of 46 infants treated successfully with oral atenolol, a selective beta-1 blocker.     

Pathogenese der Neurodermitis disseminata: Zirkulation und neurovegetative Regulation

Ohne Zusammenfassung

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婴儿血管瘤和血管畸形的治疗

婴儿血管瘤（草莓状血管瘤）和血管畸形是婴幼儿常见的血管异常,两种疾病对患儿的健康和美观有很大的影响。婴儿血管瘤具有自然消退的生物学特征,血管畸形则不会自行消退。关于婴儿血管瘤和血管畸形的治疗一直存在争议,有观点认为可以观察不需积极治疗,但有学者认为,应早期积极治疗。概述婴儿血管瘤和血管畸形在治疗与否、治疗时机和治疗方法上的选择。     

Amantadine-induced livedo reticularis - Case report

Livedo reticularis is a spastic-anatomical condition of the small vessels which translates morphologically by a reticular pattern, interspersing cyanosis, pallor and erythema. The same can be congenital or acquired. Among the acquired, we highlight the physiological livedo reticularis and the idiopathic livedo by vasospasm; the latter configures the most common cause. The drug-induced type is less common. The drugs amantadine and norepinephrine are often implicated. Cyanosis is usually reversible if the causative factor is removed, however, with chronicity, the vessels may become permanently dilated and telangiectatic. We report a case of a patient diagnosed with Parkinson’s disease with chronic livedo reticularis associated with the use of amantadine and improvement after discontinuation of the drug.