Whether caused by disease, injury, or the wear and tear of time, there are many ways redness and superficial blood vessels can appear as blemishes on the skin’s surface.
Acquired vascular lesions sometimes arise as a sign of an underlying medical condition or in response to an injury. More commonly, they are merely spontaneous benign superficial anomalies. Just about everybody eventually gets a few with age, acquiring “spider veins” on the face or legs, bright red “cherry spots” on the trunk, or patchy, ruddy skin on the neck and chest.
Port-wine stains are seen in three to five out of every 1,000 children born in North America and are located on the face and neck in up to 90 percent of all cases. They apparently form sometime during early fetal life, when for unknown reasons a group of rogue blood vessels appears. These abnormally enlarged capillaries, clustered together just beneath the surface of the skin in the upper part of the dermis, shows through the skin’s surface as a flat red mark with sharply defined borders.
Port-wine stains are usually evident at birth. Although initially they may be so pale in color that they do not seem to be serious, they become progressively darker with time. Typically, they grow proportionately with a child, although they may suddenly expand because of changes in the circulatory system or hormonal fluctuations such as those that occur in puberty. Port-wine stains are usually bright red by the end of childhood, deep claret by early adulthood and dark purple by middle age. They may become raised and develop nodules.
Hemangiomas, or “strawberries” as they are sometimes called, are noncancerous tumors comprised of superfluous blood vessels. Unlike the malformed capillaries in a port-wine stain, the excess blood vessels that make up a hemangioma are essentially normal. There are just too many of them.
The hallmark of a hemangioma is rapid growth. It may first appear as a pinpoint-size red dot, a red patch surrounded by a pale halo, or an area of blanched skin that quickly becomes infiltrated with a network of tiny blood vessels. Once visible, the tumor grows quickly, usually reaching its full size (anywhere from one to six inches or more in diameter) within a few months.
Rosacea is a chronic facial skin disorder most commonly affecting fair-skinned individuals. It is a condition of middle age, typically appearing in a person’s 30s or 40s.
Rosacea is progressive, with symptoms accumulating over the course of years. It first manifests itself as unusually persistent flushing in response to stress or exertion. The flushing worsens as the blood vessels in the “blush areas” of the cheeks, nose and chin become weakened and permanently stretched.
Over time, the flushing becomes even more pronounced, with the uncomfortable episodes lasting progressively longer. The skin always looks red and irritated; it becomes interlaced with networks of visible veins. Little hard red bumps (papules) or pus-filled pimples appear over the red areas. It is because of these bumps that rosacea is sometimes called “acne rosacea” or “adult acne.”
Poikiloderma is a sun-induced disorder in which the skin thins and becomes permanently discolored—a patchy red from telangiectiasias with overlying areas of brownish hyperpigmentation. The skin is extremely fragile and develops very fine, tissue paper-thin wrinkles. Poikiloderma usually affects the delicate vulnerable skin on the sides of the neck and upper chest.
Vascular lesions reduce and lighten after multiple treatments with a pulsed dye laser (PDL). The impact of the laser beam feels like the snap of a rubber band. A mild burning sensation, similar to a sunburn, usually follows treatment. Treated areas can remain pink for a few hours after treatment and, in some cases, bluish purple bruises (purpura) may occur. Bruises typically fade in seven to 10 days. Although improvement is often seen after a single treatment, a series of laser treatments are typically required for the best response. The treatments are delivered at six- to eight-week (or longer) time intervals.
Dr. Tina S. Alster, founding director of the Washington Institute of Dermatologic Laser Surgery, is a clinical professor at Georgetown University Medical Center in Washington, D.C. Dr. Alster earned her B.S. and M.D. degrees from Duke University where she graduated magna cum laude and was elected to Phi Beta Kappa honor society. She interned at the University of Pennsylvania Hospital and completed her dermatologic residency at Yale, specializing in laser surgery. Dr. Alster pioneered the use of cosmetic lasers, having published numerous textbooks and related articles in the medical literature and lectured at symposia and congresses worldwide. She has been honored by her peers by receiving numerous awards and accolades and currently serves as the consulting dermatologist to Lancome. Send your questions to tina@smartnow.com.
