The ultrastructure of cutaneous venous lakes

Application of Fractal Dimension and Texture Analysis to Evaluate the Effectiveness of Treatment of a Venous Lake in the Oral Mucosa Using a 980 nm Diode Laser-A Preliminary Study

Venous lake (VL) is a common lesion resulting from the enlargement of thin-walled veins surrounded by a thick wall of fibrous tissue. Photocoagulation is becoming one of the basic methods for treating small vascular lesions. The aim of this study was an application of texture analysis (TA) and fractal dimension analysis (FDA) to evaluate VL treatment. Twenty-three VLs were included in the study. We used a 980 nm diode laser, 6 W, 100 ms pulse mode with a 50% duty cycle. The total dose of energy was in a range from 80 J to 600 J. We used the difference of intensity algorithm for FDA and microcontrast and a co-occurrence matrix for TA. A complete therapeutic effect was achieved in 83%, and in 9%, scar formation was observed after three months. No healing was observed in 4%, and there was partial healing in 4%. No differences in FD were observed between the lesions after three months and the healthy mucosa. The fractal dimension and microcontrast of a vascular lesion are mutually coupled. FDA and TA is a useful and objective method of assessing treatment effects for venous lakes. The non-contact mode of the 980 nm diode laser is an effective and safe method for treating a VL.

Venous Lakes of the Lips Successfully Treated With a Sclerosing Agent 1% polidocanol: analysis of 25 report cases

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Venous lake (VL) isa venous ectasia occurring on the lips in the elderly.

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Treatment of lip venous lake includes surgical excision, laser therapy, infrared coagulation, and cryotherapy.

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Sclerotherapy is an effective and acceptable option for treatment of venous lake lesions of the lips in patients.

Background

Venous lakes of the lip is vascular ectasia that generally appears on the lower lip and other sun-damaged surfaces of skin in elderly patient. There are many local therapies for treatment of lip venous lake such as surgical excision, cryotherapy, infrared coagulation and laser therapy. Sclerotherapy as treatment is used in varicose veins, leg telangiectasia, hemorrhoids and hemangiomas but for lip venous lake only two case has been reported. Therefore, we managed this study to determine the efficacy of injection of 1% polidocanol in the treatment of venous lake lesions.

Methods

This is retrospective study. Twenty five adult patient presenting with several localizations of venous lake were enrolled in the study. Informed consent was given before the treatment and a photo of the venous lake was taken. After the lesion was cleaned with an antiseptic, was slowly injected 1% polidocanol into each patient's lesion, followed by compression for 5 min. Visual Analog Scale (VAS) scale was used to indicate patient satisfaction.

Result

Lesions were completely cleared in all patients after treatment. The lesions generally disappeared in two cases leaving an insignificant scar, in two cases become angioedema with two sessions of sclerotherapy. İn other cases side effects were not observed.

Conclusion

Sclerotherapy with polidocanol is an easy, inexpensive method and is found very effective in the treatment of lip venous lake. İn the future it offers an alternative to other classic methods.

Analysis of the Curative Effect of Alexandrite Laser in the Treatment of Venous Lake of Lips

BACKGROUND AND OBJECTIVES

Laser is being widely used in clinical treatment nowadays, including 755 nm Alexandrite laser [1,2]. This study was conducted to examine the clinical outcome of long-pulse 755 nm Alexandrite laser in the treatment of venous lake of the lip.

STUDY DESIGN/MATERIALS AND METHODS

Forty-one patients (2015-2019) were reviewed. The clinical outcomes were assessed 1 month after the treatment. The efficacy of the treatment was classified into four categories: basic recovery (most optimal outcome), effective, improvement, and ineffective (least favorable outcome). Adverse reactions were also recorded.

RESULTS

Thirty-three (80.49%) patients achieved basic recovery and 8 (19.51%) were effective; 29 (70.73%) recovered after receiving one treatment, 3 (7.32%) recovered after receiving two treatments, and 1 (2.44%) recovered after three treatments.

CONCLUSION

Long-pulse 755 nm Alexandrite laser is an effective treatment for the venous lake of the lip. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

VENOUS ECTASIA OF THE VERMILION BORDER: COPPER VAPOR LASER TREATMENT

We present the experience of application of "Yakhroma-Med" copper vapor laser system for the treatment of venouse ectasia (VE) of the vermilion border. The yellow wavelength of the generated laser radiation reaches 578 nm falls at the peak of hemoglobin absorption. The treatment was conducted in 58 patients with VE rising above the skin for no more than 1 mm. 100% clinical result. With a hemangioma size of up to 1 cm, treatment efficiency was 87% after the first procedure and complete resolution in 13% of the patients after the second procedure. At a size of more than 1 cm, the efficiency was 71% after the first procedure and 29% after the second. A 100% clinical result was obtained. The therapeutic effect persisted throughout the year in all 58 patients. It has been established that microcirculation disorders processes and further development of VE are affected by a variety of exogenous factors: about a half (48.3%) of the patients were deliberately subjected to excessive sunlight exposure, more than a quarter lived in regions with adverse climatic factors (wind, cold, abnormally low humidity, etc.) (27.6%), or regularly received hyperthermic procedures (steam bath, sauna, etc.) (25.9%). A burn (thermal, chemical) is found in the medical history of one in every five women (20.7%). 17.2% of the patients indulged in excessive consumption of condimental, spicy and hot food.

Treatment of venous lake with multiwavelength 595 and 1064 nm lasers in Asian Fitzpatrick skin type IV patients

BACKGROUND

Multiwavelength lasers are reportedly useful for treating venous lake (VL) in Caucasian patients. However, the same parameters may not be safe for Asian patients with Fitzpatrick skin type (FST) IV.

PURPOSE

Report experience with using multiwavelength laser for VL treatment in Asian patients with FST IV.

METHODS

Seventeen episodes of VL in 15 Chinese patients with FST IV were treated. 595-nm pulsed dye laser (PDL) followed by 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser was administered. The treatment was performed with 7-mm spot size at 7-11.5 J/cm² , 2-10 ms with PDL, followed with Nd:YAG at 35-40 J/cm² , 15-40 ms. The laser treatment was performed with a single pass without overlap.

RESULTS

Complete resolution was observed in 14 lesions after 1-2 treatment sessions, with 10 ms duration of PDL. The remaining three patients achieved 80%-90% resolution after 1-3 treatment sessions, with 2 ms duration of PDL. Only one case exhibited recurrence after 1 year.

CONCLUSION

Multiwavelength laser treatment for VL is highly effective and safe in Asians, although a much lower fluence of Nd:YAG is used, as compared to that used in Caucasians in the literature. Moreover, an appropriate PDL pulse duration (10 ms) ensures better outcomes.

Minimal Invasive Approach for Lips Venous Lake Treatment by 980 nm Diode Laser with Emphasis on the Aesthetic Results. А Clinical Series

INTRODUCTION

A venous lake (VL) is a vascular lesion with common occurrence in many patients, manifested as a dark blue-to-violet compressible papule, caused by dilation of venules. The main reasons for the treatment of VL are aesthetic. The haemorrhaging episodes or impairment of oral normal functions are also under considerations. Treatment of lip VL includes surgical excision, selective photocoagulation, cryotherapy, sclerotherapy and electrodessication. The high-intensity diode laser is an option. The 980 nm diode laser is selectively absorbed by haemoglobin and selectively destroys blood vessels, minimising injury to the surrounding healthy skin.

AIM

The purpose of this study was to evaluate the effectiveness of diode laser in the treatment of VL lesions with the accent on the postoperative defects and aesthetic results.

METHODS

35 patients aged 37 to 71 were included in this study. A 980 nm diode laser was used in noncontact mode, under local anaesthesia in continuous wave (2-3W, for 20-60s). All patients received only one procedure.

RESULTS

Healing process was completed within 2 to 4 weeks after treatment with no scarring. None of the typical adverse effects were observed in the process of healing.

CONCLUSIONS

Selective photocoagulation is an effective method for treatment of VL. Lower morbidity, minimal patient discomfort and satisfactory functional and aesthetic results are favourable for patients. To optimise the results and to reduce the adverse effects, basic knowledge on lasers and laser-tissue interactions is requisite.

Successful Management of Lip and Oral Venous Varices by Photocoagulation with Nd:YAG Laser

AIM

This study assessed the effectiveness of photocoagulation with Nd:YAG laser in the treatment of lip and oral venous varices.

MATERIALS AND METHODS

Sixteen consecutive patients (eight men and eight women, mean age 56 years) diagnosed as having either lip or oral venous varices, were examined and treated with a noncontact Nd:YAG laser. As lesions were small (less than 1 cm), round or oval in shape, flat, dark to blue in color and symptomless, patients sought for treatment either for esthetic reason, bleeding or cancerophobia-related concern.

RESULTS

All but one lesion were successfully treated with only one irradiation exposure. Healing was completed in about 2 to 4 weeks; none of the patients experienced complications or recurrence. Pain was out of any major concern during immediate follow-up.

CONCLUSION

Although photocoagulation with Nd:YAG laser did not outperform the effectiveness observed with diode laser (data shown in a previous study),(17) it proved to be safe and effective for the treatment of lip and oral varices, with consistent results.

CLINICAL SIGNIFICANCE

Most of patients with oral and lip varices only need some clinical advice regarding the their nature of their lesions. Yet, for those who seek treatment for this conditions, the use Nd:YAG laser is an option as it yields satisfactory outcomes.

Venous lake of the lips treated using photocoagulation with high-intensity diode laser

OBJECTIVE

To evaluate the effectiveness of photocoagulation with high-intensity diode laser in the treatment of venous lake (VL) lesions.

BACKGROUND DATA

VL is a common vascular lesion characterized by elevated, usually dome-shaped papules, ranging in color from dark blue to dark purple, seen more frequently in elderly patients. They often occur as single lesions on the ears, face, lips, or neck. Once formed, lesions persist throughout life. Although these lesions are usually asymptomatic, they can bleed if injured.

METHODS

Seventeen patients (7 men and 10 women) with VL on the lip were treated using a noncontact diode laser (wavelength 808 nm, power output 2-3 W in continuous wave).

RESULTS

After only one irradiation exposure, all lesions were successfully treated. Healing was completed in approximately 2 to 3 weeks, and none of the patients experienced complications. Postoperative discomfort and scarring were not present or were minimal.

CONCLUSION

Photocoagulation with high-intensity diode laser is an effective, bloodless procedure for the treatment of VL.

The Effect of 0.5% Sodium Tetradecyl Sulfate on a Venous Lake Lesion

BACKGROUND

A venous lake lesion is a venous ectasia that occurs on the exposed skin of elderly people. Although a number of therapies such as surgical excision, laser therapy, infrared coagulation, cryotherapy and sclerotherapy have been used to treat venous lakes, there is no guideline for treating this lesion.

OBJECTIVE

The purpose of this study was to determine whether 0.5% sodium tetradecyl sulfate (STS) is effective for the treatment of venous lake lesions.

METHODS

Twelve patients with venous lake lesions were enrolled In this study. After proper antiseptic preparation, 0.5% STS was slowly injected into each subject's lesion, and this was followed by immediate compression for 10 minutes.

RESULTS

After treatment, all of the patients' lesions cleared completely. The average number of treatments was 2.15±1.28. Two patients experienced mild side effects such as light pain and paresthesia, and these soon disappeared. There were no serious side effects reported during treatment. The mean follow up period was 29.58±13.48 months.

CONCLUSION

We have demonstrated that sclerotherapy with 0.5% STS was quite effective for treating venous lake lesions, and this treatment caused no serious adverse effects.

Vascular tumors of the skin: A selective review

Cutaneous vascular proliferations are a vast and complex spectrum. Many appear as hamartomas in infancy; others are acquired neoplasms. Some vascular proliferations are hyperplastic in nature, although they mimic hemangiomas, i.e., neoplasms. The vast majority of the vascular lesions are hemangiomas. Between the hemangiomas and frankly angiosarcomas, there is a group of neoplasms that are angiosarcomas, albeit ones of low grade histologically and, probably, biologically. The term "hemangioendothelioma" has been created to encompass these neoplasms. Vascular proliferations are, fundamentally, composed of endothelial cells. Some hemangiomas, however, contain also abundant pericytic, smooth muscle, or interstitial components, or a combination of them. These heterogeneous cellular components are present usually in hemangiomas. Some of the newly described vascular proliferations, however, are difficult to differentiate from some of the angiosarcomas. Others are markers, occasionally, of serious conditions such as Fabry's Disease (angiokeratoma) and POEM's syndrome (glomeruloid hemangioma). Kaposi's sarcoma continues to be an enigma. The demonstration of Herpes virus 8 in this condition raises doubt about its neoplastic nature. The demonstration of endothelial differentiation of its nodular lesions is tenuous and its true nature remains unresolved. While physicians have known about post-mastectomy angiosarcomas from the origin of the radical mastectomy, a new group of unusual vascular proliferations of the mammary skin are being defined. These lesions arise in the setting of breast-conserving surgical treatment with adjuvant radiation therapy. The incubation period is usually 3 to 5 years, in contrast with the 10, or more, in classical cases of post-mastectomy angiosarcoma. These lesions usually are subtle, both clinically and histologically, in contrast with the "classical," dramatic presentation of mammary angiosarcoma. The spectrum of findings ranges from "simple" lymphangiectasia-like vascular proliferations to unequivocal angiosarcomas. The pathogenesis of these lesions remains a mystery. There are very few clues that allow one to separate hemangiomas from angiosarcomas. The presence of heterologous cellular elements and, particularly, well-developed smooth muscle components tends to favor a hemangioma. Similarly, the presence of thrombosis usually supports hemangioma. Nevertheless, there are no unequivocal or reliable individual diagnostic criteria. A thorough knowledge of the different conditions and their differential diagnoses eventually leads to the proper diagnosis in most cases.

Venous lakes of the vermillion lip treated by infrared coagulation

We reviewed the treatment of 20 venous lakes by infrared coagulation in 18 patients. Seventeen cleared after one treatment; in three patients a further treatment was required, and one patient needed a total of three sessions to clear the venous lake. At 1-6 months follow-up there was complete clearance with no discernible mark in all but four patients who had minimal scarring, including the patient who had three treatments.

Venous lake of the lip treated with a sclerosing agent: report of two cases

BACKGROUND

A venous lake is a venous ectasia that appears mostly on the lower lip and other sun-exposed areas of an older person. Treatment of lip venous lake includes surgical excision, laser therapy, infrared coagulation, and cryotherapy. Although the use of sclerotherapy on varicose veins, leg telangiectasia, hemorrhoids, and hemangiomas is well established, the use of sclerotherapy for lip venous lake has not been reported.

OBJECTIVE

We present two cases of lip venous lake treated with intralesional injection of 1% polidocanol.

METHOD

Two cases are reported, and literature is reviewed.

RESULT

The lesions virtually disappeared, leaving an inconspicuous scar, with two sessions of sclerotherapy. Side effects were not observed.

CONCLUSION

Sclerotherapy with polidocanol is effective in the treatment of lip venous lake and offers an alternative to conventional methods.

Venous lakes: a report of 32 cases treated by carbon dioxide laser vaporization

Venous lakes (VL) are acquired venous ectasies of the superficial dermal venules, usually observed in older people. Thirty-two adult patients with VL in several localizations were treated by carbon dioxide laser vaporization. Two passes were performed to each lesion within the same session. A continuous and defocused mode, with a power density of 5 W/cm2, was used in the first pass, and a continuous focused mode with the same power density was in the second pass. Photographic controls were performed before and after treatment. VLs were removed, and the smooth surface of the treated area was re-established by a single laser session. Only one case recurred after the treatment. No significant secondary effects were observed. Carbon dioxide laser is a good and safe method for treatment of skin VL. With adequate cautions, excellent cosmetic results can be obtained with a single session of treatment.

Cutaneous vascular anomalies. Part I. Hamartomas, malformations, and dilation of preexisting vessels

Classification of cutaneous vascular anomalies is difficult because conceptual confusion persists between vascular neoplasms and malformations. However, hemangiomas of the infancy fulfill criteria both for hyperplasia and neoplasm because they result from proliferation of endothelial cells, but often undergo complete regression. Despite these pitfalls we have classified cutaneous vascular anomalies into the following categories: hamartomas, malformations, dilatations of preexisting vessels, hyperplasias, benign neoplasms, and malignant neoplasms. In this first part of our clinicopathologic review of vascular anomalies, hamartomas, malformations, and dilatation of preexisting vessels are covered. Hamartomas include several combined vascular and melanocytic proliferations grouped as phakomatosis pigmentovascularis and the so-called eccrine angiomatous hamartoma that consists of proliferations of both eccrine glands and blood vessels. Vascular malformations result from anomalies of embryologic development, and in some of them the abnormalities of the involved vessels are more functional than anatomic, as is the case of nevus anemicus. In contrast, other cutaneous vascular malformations show striking morphologic abnormalities of the vascular structures. These anatomic vascular malformations are subdivided into the following groups: capillary, venous, arterial, lymphatic, and combined anomalies. Spider angioma, capillary aneurysm-venous lake, and telangiectases are not vascular proliferations at all, but dilations of preexisting vessels. In our opinion, most of the lesions described with the generic term of "angiokeratoma" are not authentic vascular neoplasms, but hyperkeratotic malformations of capillaries and venules or acquired telangiectases of preexisting blood vessels of the papillary dermis. Therefore the first group of these "angiokeratomas" are included in the vascular malformations section, and the second group are covered in the section of dilation of preexisting vessels. Lymphangiectases are considered the lymphatic counterpart of angiokeratomas because they result from ectasia of preexisting lymphatic vessels of the papillary dermis.

Venous lakes (Bean-Walsh) of the lips--treatment experience with the argon laser and 18 months follow-up

The intense blue-green light of the argon laser has proven very effective in the treatment of a great variety of vascular skin disorders. Venous lakes (Bean-Walsh) of the lips are blood-filled dome-shaped lesions, their treatment often requiring surgery. Fifty-one patients suffering from this disorder were treated with the argon laser with 1.5-2.0-mm spot size, 0.3-s pulse duration and 1.8-3.0-W power. In most cases treatment was carried out without local anaesthesia. Laser impact was followed immediately by shrinking of the lesions and replacement by a whitish-grey plaque. Excellent cosmetic results were obtained in 90% of the patients. Three patients showed mild scarring. At 18 months follow-up only one patient showed a recurrence. The argon laser appears to be a highly effective non-invasive treatment modality for venous lakes of the lips.