An angioma is a reddish vascular lesion that is found on the skin. It is made up of small clumped blood vessels that give it this characteristic appearance.
Angiomas can appear at birth or during the first six months of life, persist until adulthood, or appear from the age of 20 or 30. For this reason, depending on the age of the person, the characteristics and appearance of the angioma will be different.
Types of angiomas
Infantile hemangioma develops within the first 3 months after birth. It takes on the appearance of a red spot, like a crushed strawberry. While the cause of infantile angioma remains unknown, certain risk factors such as late, multiple, or difficult pregnancy (hypertension, pre-eclampsia, etc.) play a definite role in the appearance of these angiomas.
This type of angioma is relatively common, around 10% of babies have them. Infantile hemangiomas regress naturally within a few years and do not require any treatment in the majority of cases. However, they can sometimes be responsible for functional complications or risk leaving an unsightly scar that persists in adulthood.
Treatment can therefore be offered early, from the 5th week of life.
Plane angioma, also called wine stain, does not go away over time. It is a rare angioma, which affects less than 1 in 1,000 babies. There are several types of plane angiomas which vary according to size, color, shape, etc. The plane angioma should not be confused with nevus flammeus or port-wine, a pinkish medio-facial spot very common at birth that disappears in patients within the first months of life.
It is therefore very important to consult a specialist to establish the diagnosis.
Venous angioma is the so-called birthmark, consisting of a plexus of blood vessels. Depending on the location, its danger may increase, from harmless to fatal.
These are small red spots that appear with age. Ruby angiomas are most often localized on the trunk and limbs. They appear as small grains a few millimeters in diameter, protruding from the surface of the skin, bright red in color. They are sometimes responsible for bleeding if they are scratched. They don’t go away when pressed. They result from the deformation of a blood capillary. They can be removed by laser treatment or by electrocoagulation.
Stellate angiomas appear as stars, hence their name. They are often seen in people with fair skin. In the vast majority of cases, the cause is not known, but they often develop in large numbers in people with cirrhosis and in many women who are pregnant or taking oral contraceptives. Stellate angiomas are not present at birth.
Stellate angiomas are usually about 0.5 centimeters in diameter. They are harmless and asymptomatic but can cause cosmetic problems.
Stellate angiomas that develop during pregnancy or when taking birth control pills go away on their own within 6 to 9 months of giving birth or stopping the contraceptive.
Treatment is not necessary, but when treatment is desired for cosmetic reasons, doctors can destroy the central portion of the vessel with a laser.
Venous angiomas are caused by venous malformations. A venous angioma is a congenital anomaly that is characterized by red spots on the skin; the result of a malformation at the level of a vein.
The malformation may arise in different parts of the body. Depending on the affected region, it can for example cause breathing difficulties if it appears in the pharynx or vision disturbances if it appears on the face. Cerebral angiomas are the most common. Neurosurgery is the treatment of choice.
Plane angiomas are also vascular malformations. Their most common location is the head (eyelids, neck, and forehead). It is often confused with nevus flammeus because of its characteristics of smooth skin and it’s red but they are not the same. Plane angiomas are generally a reason for aesthetic consultation when it is very marked in adulthood.
When to treat an angioma?
Not all angiomas need to be treated. Treatment may be considered in the following situations:
- The angioma is large (it is over 2 cm).
- Its location is problematic: near the eyelid, around the eyes, mouth or respiratory tract (throat, pharynx), for example.
- It causes significant aesthetic discomfort, even a risk of disfigurement, and is likely to have significant repercussions in a person’s social life.
- It’s is likely to bleed.
- The angioma is painful.
Whether it is a child or an adult, in all cases, a competent doctor should be consulted who will establish the diagnosis and refer the patient to a dermatologist or pediatric dermatologist.
Treatments for angiomas
In the case of infantile hemangioma, as a first-line treatment, Propranolol, a drug that belongs to the class of beta-blockers, may be prescribed. It is usually given for a period of 6 months. To prevent a recurrence, treatment can be continued until the age of one. Very effective, this treatment has a contraindication for children with asthma. In addition, and depending on the case, one or a few laser sessions may be considered.
For all other types of angioma, laser treatment is the most indicated treatment. It has been recommended in the treatment of angiomas for about 40 years.
Several types of lasers responding to different wavelengths are recommended: pulsed dye laser, Dye-VL (narrow spectrum pulsed light), KTP laser, and more incidentally ND-Yag in very specific cases. The laser works either by coagulation by the effect of heat or by exploding the vessels which are then eliminated by the macrophage cells.
For certain venous angiomas, vascular surgery and sclerotherapy may be considered either in addition to or as a replacement for laser.
Finally, if there are still sequelae, surgery can finalize the treatment.
Laser treatments require certain precautions:
- Lasers can cause considerable damages to the skin especially in people with darker shades.
- Pregnant women, people with epilepsy, who have a pacemaker and those taking photosensitizing drugs (antibiotics, anti-inflammatories), or anti-coagulants cannot be treated with lasers.
- Depending on the location of the angioma (too close to the eyes, on a mucous membrane, on the scalp, etc.), laser treatment may not be possible.
- It is recommended to avoid the sun for 2 months after the operation.
- There is no guarantee of the effectiveness of the procedure but the results are generally very satisfactory”.
The number of sessions varies according to the type of angioma but also according to other criteria such as the extent of the angioma’s surface, its depth, etc. From patient to patient, the number of sessions may be different, even if the angiomas are visually similar. For example, the treatment of a planar angioma can be spread over 30 sessions, while ruby angioma can be treated in one session.
After the session, depending on the action technique chosen, edema (for 48 hours after the operation) or purpura may appear (the angioma turns purple for 10 to 15 days before becoming lighter again). These reactions are “normal” after the procedure.