Teleangiectasia is a local or widespread dilation of small-caliber vessels of non-inflammatory origin, accompanied by the development of a persistent cosmetic defect. In connection with the fact that according to the morphological characteristics of telangiectasia is a stain on the skin of the stellate form, this vascular pathology is often referred to as the "vascular star". Localized telangiectasias exclusively in the outer layers of the skin and most often have small dimensions, which favors their elimination by laser irradiation or sclerotherapy.
The risk group for this vascular pathology is made up of individuals under 45 years of age, as well as children immediately after birth. According to the world statistics, most women who have at least one birth in the anamnesis suffer from telangiectasia.
The causes of telangiectasia
Specialists in the field of vascular surgery allow for several etiopathogenetic theories of the origin of telangiectasia. Some of them prefer the "hormonal theory", according to which the expansion of the lumen of a small-caliber vessel is the result of hormonal disorders in the human body, which explains such a huge percentage of the incidence of telangiectasia among pregnant and parturient women. For the same reason, the majority of patients who take long-term hormonal drugs (glucocorticosteroids, oral contraceptives) suffer from telangiectasia.
In addition, there are a number of pathologies of the dermatological profile, which can be a background for the development of telangiectasias and to such include: pigment xeroderma, rosacea , radiation dermatitis.
Various variants of cardiovascular diseases, accompanied by the defeat of small-caliber vessels ( Raynaud's disease , varicose veins ) in almost 100% of cases provoke the formation of telangiectasias.
It should be borne in mind that even an absolutely healthy person who does not suffer from any vascular or skin disease can develop telangiectasias as a result of the negative impact of provoking risk factors in the form of direct exposure to sunlight, which occurs with frequent visits to a solarium, smoking and alcohol abuse, adynamia.
Specialists in the field of vascular surgery share telangiectasies on the etiopathogenetic trait on primary (hereditary), which are most often observed among children of childhood, and secondary (developing against a background of some other pathology).
The main pathogenetic mechanism of the formation of telangiectasias in the projection of the lower extremities is a local impairment of blood circulation and an increase in the gradient of intravascular pressure, which is similar to varicose disease. The only difference is that with telangiectasia, vessels of small caliber suffer.
Symptoms and signs of telangiectasia
Vascular telangiectasias can be located on the skin of virtually any part of the body, but there are "favorite" localizations of this vascular pathology: the face, upper and lower extremities, and neck.
Since, skin telangiectasia can develop as a result of the defeat of small vessels of both the venous and arterial bed, there are many variations in the shape, color and size of the skin elements. The telangiectasias formed as a result of local dilatation of arterioles and capillaries have a bright red color, clearly defined stellate contours, and disappear upon palpation, which is a pathognomonic sign when they are detected. The venous type telangiectasia is characterized by the formation of a variety of dark maroon spots with a bluish tinge, which rise above the surface of the skin.
Most often, telangiectasias are local in nature, however, in some situations, skin lesions are observed over a large extent and the formation of a huge number of spots of various shapes, sizes and colors.
In addition to the general specific manifestations of telangiectasia, there may be some individual characteristics that depend on the development of vasodilation against the backdrop of which pathology. Thus, with systemic lupus erythematosus, small capillaries are more affected in the projection of nail ridges, combined with hyperpigmentation. Expansion of the vessels, blood supplying the fingertips, with dermatomyositis is accompanied not only by the formation of telangiectasias, but also by a pronounced pain syndrome in this area.
Essential generalized telangiectasia of the lower limbs is characterized by an unfavorable progressive course and is characterized by the formation of small spots in the projection of the feet, which quickly spread to other parts of the trunk.
Teleangiectasia in newborns is manifested by the formation of the so-called " marble skin ", which has the form of a red mesh, manifested with excessive physical or psycho-emotional activity.
Teleangiectasias can have a tree-like, linear, stellate or spotted shape. Tree-like telangiectasias are most often localized on the skin of the lower extremities, and on the face are mainly linear forms of this pathology.
Teleangiectasia in children of newborn age occurs in more than 80% of cases and is a transitory compensatory condition, in most cases not requiring medical intervention. The appearance of telangiectasia in these cases is due to the presence of a physiological rudimentary embryonic vascular remnant. In newborn children, the favorite location of telangiectasis is the occipital region, various parts of the face and especially the lips. In the development of congenital telangiectasia, an important role is played by the effect on the human organism of a high level of estrogen in the mother. In ataxia-telangiectasia, which is an immunodeficiency disease, in addition to skin lesions, the child has a lesion of the vascular bed of all internal organs.
Telangiectasia on the face
There are a number of specific diseases, accompanied by the development of telangiectasias located on certain areas of the face. So, scleroderma formation is characterized by the formation of speckled form of telangiectasies, which develop in numerous numbers on the skin of the face and sometimes can have rather large dimensions of individual elements (up to 7 mm in diameter).
Hemorrhagic telangiectasia, which is observed in Rundu-Osler disease, is most often accompanied by the formation of vascular enlargements of the oral mucosa, and may also be located in the region of the wings of the nose. With a long course of the disease, telangiectasias can form not only on the skin but also on the internal organs.
Hereditary telangiectasia can be accompanied by damage to the skin of the face on a large extent, but under no circumstances there is a formation of spots on the mucous membranes, which fundamentally distinguishes it from hemorrhagic telangiectasia.
In pediatrics, ataxia-telangiectasia is most common, which affects the skin of the face in the projection of the nasal septum, the auricles, the palate and the conjunctiva. In the case of nevoid telangiectasia, a specific lesion occurs in the neck vessels localized near the location of the neural bundle.
Treatment of telangiectasia
Currently, specialists in the field of cosmetology and vascular surgery offer a wide range of techniques that allow to level the manifestations of telangiectasia. One of these methods is sclerotherapy, which allows the removal of telangiectasia quickly and efficiently. The main advantage of sclerotherapy is its low invasiveness and ease of use. Manipulation involves the introduction into the lumen of a vessel of sclerosant, the action of which is directed to the obliteration of the vessel. Of course, one of the stages of sclerotic obliteration is the formation of a connective tissue strand, but over time this neck is subjected to independent resorption and does not require medication. The field of sclerotherapy is venous telangiectasia, while for the elimination of capillary-type telangiectasia this technique does not find its application.
Like any medical technique, sclerotherapy can be used in various modifications, depending on the individual features of manifestations of telangiectasia. For example, sclerotherapy of telangiectasia with segmental varicose is performed in several sessions and after its application, the patient may experience the formation of local hyperpigmentation, which self-leveling within six months.
Microsclerotherapy, as a treatment option for telangiectasia of small caliber reticular veins, should be combined with preliminary cooling wraps to enhance the effect. In most cases, two or three sessions are sufficient for complete obliteration of the vessel.
When choosing this or that variant of sclerotherapy it should be taken into account that this manipulation belongs to the category of cosmetic procedures and eliminates only the external manifestations of telangiectasia. With the passage of time, telangiectasias can form in other parts of the trunk, since the root cause of their occurrence is not eliminated by sclerotherapy.
In a situation where telangiectasias are localized on the face, more often a more modern method of their removal is used - laser coagulation, which implies insertion into the lumen of the vessel of a special catheter equipped with a laser radiation source. When the laser acts in the lumen of the vessel, a large number of vapor bubbles form, which damage the inner shell of the vascular wall, thereby provoking replacement of the lumen of the vessel with a connective tissue. Small caliber teleangiectasia disappears after the first laser coagulation session, while larger "vascular asterisks" need repeated procedures.
The main criteria that guide cosmeticians in choosing a method of eliminating telangiectasis is the maximum effectiveness and minimal detrimental effect on the body. These requirements are most consistent with selective laser coagulation, which has increasingly become used in the treatment of telangiectasias. The basis of the method is the absorption of the laser by skin cells and the conversion of light energy into thermal energy, accompanied by selective damage to the extremely affected vessels, while healthy surrounding tissues remain intact. Due to this selective approach, the possibility of forming coarse connective tissue intradermal scars is minimized, which occurs with other methods of treatment. With the help of selective laser coagulation, it is possible to eliminate telangiectasias of any localization in 90% of cases, and in the generalized form a significant decrease in their size is observed.
As a preventive measure to reduce the manifestations of congenital telangiectasia, a modification of the patient's lifestyle should be considered, which implies a sharp restriction in the use of alcohol, smoking, avoiding the body's hypothermia, and direct sunlight.
? Teleangiectasia - which doctor will help ? If there is or suspected development of telangiectasia, you should immediately seek advice from such doctors as a vascular surgeon and dermatologist.