telangiectasia disease (telangiectasis) Department of superficial skin and mucous membrane of small blood vessels on the was sustained for various reasons the expansion, the formation of red or purple macular, point-like, linear or stellate-like damage.
[Category]: telangiectasia divided into primary and secondary categories. The former unknown reasons, the latter secondary to other known diseases. In addition, the skin of healthy people as well mucosa telangiectasia can occur, often, young women's legs and face, some people such as idiopathic telangiectasia telangiectasia.
1. Telangiectasia telangiectasia primary incentive is often unknown, can be found in the skin hemangioma, vascular angle skin tumors, hereditary hemorrhagic telangiectasia , ataxia telangiectasia, spider-like telangiectasia psychosis.
2. Vasodilation secondary hair
(1) there telangiectasia skin : Many skin telangiectasia may occur, such as rosacea, poikiloderma, keloids, dry skin color of the disease, radiation dermatitis.
(2) with telangiectasia systemic diseases: liver disease such as cirrhosis, endocrine diseases such as hyperthyroidism, ovarian and pituitary diseases, connective tissue diseases such as systemic lupus erythematosus, dermatomyositis, and some heart disease, atherosclerosis and lead poisoning are visible telangiectasia.
(3) physical factors: long-term exposure to sunlight, ionizing radiation, X-ray irradiation, etc., long-term exposure to wind, cold, hot seamen, cooks, athletes can occur capillary vasodilation.
(4) Drug factors:
① Oral: Oral hydralazine if other drugs can cause lupus-like syndrome , skin telangiectasia;
② External: Long-term topical corticosteroid can efficient local skin telangiectasia and atrophy, topical fluorouracil 1% propylene glycol can also be caused by persistent local skin telangiectasia;
③ injection: local injection of corticosteroid suspension also enable local skin telangiectasia and atrophy.
[clinical]: appears in the skin or mucous membrane red or purple mottled, dotted, line like, stellate-shaped, dendritic-like damage, or recklessly. Distribution can be localized or widespread, or consistent with the blood vessels and nerves, or showed a side of sex. Common in the face, lateral femoral, dorsalis pedis and trunk and so on. Most of the pressure of the slide fade, remove the slide after the resumption of primary colors. More no symptoms, sometimes burning or irritation, no bleeding tendency. Spider telangiectasia, also known as spider angioma, the skin lesions more special, the central grain of rice to corn kernels to a bright red rash-like uplift, called spider, slide the visible pulse pressure (small arteries), surrounded by spider radial expansion of the wool
small blood vessels, said the spider legs, with Huo Chaitou constant pressure when the central spider spider legs that disappeared after removal of the pressure of restitution, spider common in pregnant women, children and patients with liver disease. i
[pathological]: visible expansion of the dermis, irregular thin-walled capillaries and veins. Central angioma is a lesion upstream arteries, up to the arteries under the skin to expand into a thin-walled ampulla, slim as a center of arterial branches to the surrounding radiation, again divided into many capillaries. The arterial wall smooth muscle, endothelial cells and sometimes between the internal elastic membrane may contain red blood cells.
[diagnostic]: based on history and clinical diagnosis is usually not difficult to be distinguished is primary and secondary, secondary primary disease were taken because of specific incentives.
[laser treatment]: in the past CO 2 laser (10 600am), Continuous Nd: YAG laser (1 064nm), argon laser (514.5nm), krypton laser (568nm), copper vapor laser (578nm) and so for the treatment of telangiectasia, although has a good effect, but these reactions after laser treatment, side effects and more easily scar, now rarely used. The treatment effect is significant telangiectasia and safe treatment of high instrument with a long pulsed dye laser, variable pulse width frequency Nd; YA PhotoDerm laser and intense pulsed light and so on.
1. Anesthesia
general anesthesia used, use 5% EMLA anesthetic cream applied to the lesion, covered with food wrap, 1h or so.
2. Treatment
(1) FPDL (585nm): treatment of the energy density of 7-9.5J/cm 2 , spot 2-3mm. 350-500μs pulse width, or 1 500μs, FPDL smaller diameter vascular lesions for better effect, but the poor efficacy of coarse capillaries. Purpura after treatment, the skin appeared a considerable number of people have pigmentation, but can also have soft tissue edema, blister formation and other side effects.
(2) Vbeam: as a new variable pulse dye laser, wavelength 595nm, pulse width of 1.5-40ms, the treatment energy density 6-20J/cm 2 , to do 1-3 times the local radiation, can receive the desired effect. Purpura does not occur after surgery, some also have pigmentation. Soft tissue edema, blister formation and other side effects.
(3) variable frequency pulse Nd: YAG laser (532nm): treatment of the energy density of 9-18J/cm 2 , spot 2 -4mm ,5-50ms pulse width ,4-5 0 C synchronous cooling (careful not to push too heavy cool head, to avoid all out of the blood vessels to affect efficacy), doing a local -3 over the radiation, can be seen after treatment of small (2 mm in diameter or less) capillaries disappear immediately, the larger blood vessels coagulation darken. After 1-3 times of treatment, most of telangiectasia can be cured. VersaPulse new laser spot due to the larger diameter and longer pulse width, the laser's capabilities have been expanded, larger diameter in the lower limb vasodilator in the treatment of hair has a distinct advantage. VersaPulse is the treatment of telangiectasia treatment for one of the best. Side effects with the Vbeam.
(4) PhotoDerm or Quantum of intense pulsed light: ① PhotoDerm treatment of telangiectasia can choose 550 nm, 570nm, 590nm and other band width can be 3-5ms, option 1 - three pulses, the energy can be 40-60 J/cm 2 . PhotoDerm diameter in the treatment of leg telangiectasia thick and has some advantages. If operating properly, rare side effects after the application PhotoDerm telangiectasia markedly effective treatment rate of 90% or more. PhotoDerm is currently the treatment of telangiectasia treatment for one of the best. ② Quantum treatment is called " IPL " surgery - with a wavelength of 560nm as the treatment of head and pulse width can be 2.8-5.2ms, often choose 2-3 pulse, pulse interval 15-30ms, with energy density 25-35 J/cm 2 . Interval of 3-4 weeks after about 5 times the treatment, most can achieve significant efficacy, IPL highlight the advantages of surgery after almost no side effects, the disadvantage is treatment more frequently.
3. Complications and management
(1) soft tissue edema: often occurs in the eyelids, face, generally subside within a few days.
(2) purpura: occurs with 585nm dye laser treatment, often self-limiting for 2 weeks, without special treatment.
(3) pigmentation: a few patients after treatment with laser light pigmentation reaction, generally do not have treatment, if necessary, a topical 0.025% 0.05% D A acid ointment to Accelerated color dissipated.
(4) blister formation: laser energy is too high, the cooling measures, and so can not use the skin damage caused by blister formation, treatment should do first spot test, the energy lost to the capillary for the degree of darkening or color, white is obvious that energy is too high. After the blisters appear, removing large blister fluid can be sterile dressing, do not deal with the smaller self-absorption.
(5) relapse: 2-4 weeks after treatment with revascularization induced relapse. 2nd recurrence can be treated, 2nd illuminated area should be slightly wider than the 1st slightly darker more.
4. Efficacy evaluation of laser treatment of vascular disease, the effect of the telangiectasia is the best and most effectual 1 rule can be made, generally 1 - 3 can be cured. Thick blood vessels to use a longer pulse width of the laser treatment, smaller vessels can be used short laser pulse. Expansion of the capillary limb sometimes coarse treatment more difficult, often have several treatment Shike Jia large pulse width, laser energy and pulse frequency.
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