Despite the unpleasant and not very reassuring appearance, the development of an angioma on the skin need not worry.
- Angioma: what is it
- The main forms
- Angioma: what to do
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Despite their unpleasant and not very reassuring appearance, the development of an angioma on the skin need not worry.
A reddish or purplish patch, of variable shape and more or less branched or raised, measuring a few millimeters or extending over an area of a few square centimeters, usually at the level of the skin or oral mucous membranes (including the tongue) or genitals .
This is the characteristic mode of presentation of angioma: a formation consisting of one or more abnormal blood vessels, in most cases superficial and visible from the outside , which can be very bothering on an aesthetic level, but usually completely harmless, not associated to other diseases and without consequences for health.
Angioma: what is it
Angiomas, more correctly called hemangiomas, are benign vascular malformations that involve almost exclusively the arterial or venous capillaries and can arise in any point of the body , although they tend to appear more often in the skin of the face , head , neck , chest and back , less frequently on the limbs.
Angioma is usually considered a benign tumor , but this classification should not worry since its presence almost never involves symptoms (or causes very mild ones) and that its growth is generally self-limited .
The only hemangiomas that deserve greater attention from the doctor and adequate therapy are those that are quite bulky, those with a high risk of rupture (resulting in blood leaking and the formation of a sore) and those that develop inside organs delicate , such as the liver (hepatic hemangioma), at the level of the eyelids or other areas of the eye (because, if left untreated, they can seriously compromise vision) and in the mucous membranes of the nose and throat (because they can create significant discomfort and interfere seriously with breathing).
In the vast majority of cases, angiomas of skin and mucous membranes affect younger children (infantile hemangioma) : sometimes they are already present at the time of birth, while more often they appear in the first months of life, continuing to grow and develop especially in the first year.
Subsequently, hemangiomas tend to enter a sort of “quiescent” phase , in which they remain stable in size and appearance, for a period of time that varies from case to case (usually a few years). As the child grows, angioma often undergoes a more or less marked spontaneous regression , which in many cases can lead to its complete disappearance, especially if the initial lesion in the skin tissue was small and shallow.
This mode of evolution means that about half of children with hemangiomas in the first year of life no longer have them at the age of 5 and that, in the majority of cases, the lesions have almost disappeared by the time they turn 10, without it was necessary to provide specific treatments, neither with drugs nor with laser or surgery.
In cases where the hemangioma, at the time of its maximum proliferation, is particularly voluminous, it is possible that, despite its substantial regression, signs, such as spots slightly lighter or darker in color than the surrounding skin or modest scars, remain on the skin (especially if the blood vessels of the childhood angioma had ruptured one or more times).
Generally, infantile hemangiomas occur in an isolated form , but it may happen that the child develops even more than one, especially in the case of twin pregnancies or when the disorder shows a recurrence in the family.
Hemangiomas of different types can also develop in adulthood , for reasons that have yet to be clarified and specified. These vascular malformations can appear as fine flat telangiectasias (ie the dilation of small blood vessels) or as protuberances of modest size due to a greater dilation of the superficial vessels of the skin. Their presence has been found in pregnant women and in people suffering from liver cirrhosis or other liver diseases (in particular, alcoholic liver disease).
A type of angioma typical of adults is that called “spider” or spider , characterized by a branched and flat appearance. Another variant of the disease very common in adulthood and in the elderly is the “cherry” angioma , so defined for the rounded appearance of the reddish lesions that appear on the skin, usually small in size and present in a variable number from a few elements to a few dozen.
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The main forms
Hemangiomas can be classified according to different criteria and, in particular, on the basis of the appearance and degree of evolution and differentiation reached at the end of the proliferation phase of the small blood-filled vessels.
Regarding the shape, size and general characteristics, childhood hemangiomas are certainly more variable than those that can develop in adulthood , but most common angiomas can be traced back to five types.
In addition to the aforementioned “cherry” hemangiomas (also called “ruby”) and “spider” (also called “stellar”), there are the “serpiginous” hemangiomas, called Hutchinson’s , from the name of the English doctor who described for the first time in 1890. They are characterized by an evolution in two phases: at the beginning they are small and not very prominent formations, but with time they widen, branching out to the periphery, attenuating in the central part and taking on a ring-shaped aspect, lattice.
On the basis of the thickness and the degree of depth reached in the skin, the tuberous angioma , confined to the superficial layers of the skin and more protruding on its surface, and the cavernous angioma , generally flat, but more developed in depth, in the tissue are distinguished. subcutaneous.
| Angioma | Features |
| Cherry (or ruby) | Roundish reddish lesions that appear on the skin, usually small in size and present in varying numbers from a few elements to a few tens |
| Spider (or star) | Branched and flat |
| Seprginosis (or Hutchinson’s) |
At first they are small formations but over time they widen, attenuating in the central part and taking on an annular, lattice-like appearance. |
| Tuberous | Confined to the superficial layers of the skin and more protruding on its surface |
| Cavernous | Generally flat, but deeper developed, in the subcutaneous tissue |
The diagnosis of angioma is neither a problem for the general practitioner nor, much less for the dermatology specialist, who will not need to prescribe in-depth examinations to understand what it is, especially when the disorder is presented. a child.
The appearance on the skin of vascular malformations of this type in adulthood may, however, deserve further investigation, for example to verify the possible presence of a liver disease not yet diagnosed.
However, it should be emphasized that scientific research has not yet been able to trace the causes of these malformations (which may, however, be different in the various cases) and that, therefore, any further tests or investigations required will depend more on the general clinical picture. of the patient examined than by the skin problem itself.
Angioma: what to do
Given its harmlessness, if the angioma is localized in a superficial non-critical position and if its presence does not cause specific disturbances or a significant aesthetic problem for the patients , the only strategy envisaged is the regular control of its evolution by the trusted doctor and / or a dermatology specialist.
The speech changes when hemangiomas are formed in correspondence of delicate organs which could compromise the correct functioning (eyes, liver, respiratory tract, heart, etc.) or when they grow too much, becoming particularly fragile and with a high risk of rupture and bleeding , or when they cause significant pain (as a consequence of the compression exerted on the surrounding structures) or, again, when they are poorly tolerated on an aesthetic level .
In all these cases, hemangiomas can be eliminated with medical therapy or through surgical removal with cold (cryosurgery) or laser or with embolization procedures . Before proceeding with any type of treatment, however, it is important to contact a dermatology specialist for an in-depth examination and for a rational evaluation of the pros and cons of the treatments available.
Especially in children, the drugs normally used to facilitate the regression of spots can have non-negligible side effects, while surgery and laser treatments, in addition to being invasive approaches and causing pain, may not have a substantially better long-term aesthetic advantage than what would be obtained by letting the hemangioma evolve, withdrawing spontaneously.
If the benefit / risk balance induces the doctor and the patient or family to opt for treatment, generally the first approach envisaged is pharmacological and involves the administration of corticosteroids by mouth, applied locally in the form of a cream or injected directly into the injuries. In this regard, it should be remembered that corticosteroids taken by mouth in childhood can interfere with the growth of the child, if used in medium-high doses and for periods longer than a few weeks.
Alternatively, drugs such as beta blockers (in particular propanolol), usually used for the treatment of cardiovascular diseases, such as hypertension and heart failure , can be proposed . Again, the drug can be applied directly to small and superficial skin lesions, or administered as an oral solution for the treatment of more severe, proliferating or ulcerated hemangiomas.
If medical therapy is insufficient or cannot be administered due to specific contraindications (for example, asthma prevents the use of beta blockers), surgical removal of the hemangioma with cold may be considered, using a technique similar to that of cryotherapy, or with the pulsed light laser .
Both of these treatments have the advantage of offering a quick fix, but are generally not recommended early on unless bulky or high-risk hemangiomas are present.
Conversely, surgery and / or lasers can help improve the appearance of the skin at a later stage, after the angioma has spontaneously regressed, leaving scars or other skin tissue malformations (for example, erythematous spots and telangiectasias).
In girls and women, small and poorly detected hemangiomas and any residual spots on the skin that are not excessively pronounced, but considered aesthetically annoying by the patients, can be easily camouflaged even by a fairly covering make-up, with high quality cosmetics, using the camouflage technique which allows you to effectively mask changes in the color or appearance of the skin.
