Medical Inspection – Health Blog

The two most commonly used kind of sclerosants for sclerotherapy are osmotic agents and detergents. Hypertonic saline and Sclerodex® (Omega Laboratories Ltd, Montreal, Canada) are osmotic agents that damage cells by shifting the water balance. Polidocanol, sodium morrhuate and STS are detergents that disrupt a vein’s cellular membrane. STS is a synthetic long-chain fatty acid salt of an alkali metal, and STS has detergent properties. It has been approved by the US Food and Drug Administration (FDA) since 1946 and STS has a long record of safety and effectiveness. Intravenous injection of STS causes intimal inflammation and thrombus formation, which occludes the injected vein and the partial or complete vein obliteration may or may not be permanent. The endothelial damage depends on the concentration of STS and this occurs immediately after injection, and the result is rapid thrombus formation. This leads to the vascular sclerosis.

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A venous lake lesion was first described by Bean and Walsh in 1956. It was previously called blueberry on the lip and senile hemangioma of the lip. The lesion is a small, bluish-purple, slightly- raised, soft papule or nodule caused by a localized vascular dilatation. The size of a venous lake varies, but most of them measure 1 to 15 mm. The lesion is usually round or oval, but the larger ones may be irregular. It often occurs on sun-damaged skin and the most common sites are the face, ears and lips.

Histopathologically, a few or multiple large, di­lated and irregular thin-walled venules are located in the upper and middle dermis. The venules are lined by a single layer of flattened endothelial cells and a thin wall of fibrous tissue. In some instances, in place of the fibrous tissue, there is a thin irregular noncontinuous layer of smooth muscle. This lesion is thought to occur as a result of deterioration in the connective tissue in the vascular adventitia, as well as in the dermis.

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No patients were lost to follow-up. Five venous lakes cleared after a single treatment, four after two treatments, two after three treatments, one after four treatments and one after five treatments. The average number of treatments needed to achieve a complete cure was 2.15 ±1.28 (range 1 to 5) and the average infused volume of STS was 0.09±0.05 cc (range: 0.05 to 0.2). After treatment, all of the patients’ lesions were completely cleared (Fig. 2). No patient experienced any recurrence with a mean follow up of 29.58±13.48 months (range 10~49 months) and there were no side effects such as swelling, inflammation, skin necrosis or hyperpig- mentation. During injection, some patients felt light pain and paresthesia, but this soon disappeared. The details of the long term follow-up results are summarized in Table 1.

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Patients

We performed a clinical study on 12 patients who

had venous lakes and who visited the Department of Dermatology, Hallym University Sacred Heart Hospital between June 2003 and December 2006. The male/female ratio was 5 males 7 females and their mean age was 52.91± 13.38 years (range 32 to 76). Twelve lesions were on the lower lip and one lesion was on the upper lip and these lesions ranged in size from 2 to 10 mm. No patient had undergone previous treatment for their venous lake lesions.

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INTRODUCTION

A venous lake is a small, dark blue, slightly raised, soft lesion that occurs on the exposed skin of elderly people. This lesion is easily compressed, and it is mainly located on the face, ear, lip, neck, forearm and back of hand. It is lined by a single layer of flattened endothelial cells and a thin wall of fibrous tissue. Although it is usually asympto­matic, treatment may be required if there bleeding after trauma to this type of lesion, which can occur frequently, or if the lesion is cosmetically disfiguring. Numerous treatment modalities have been reported in the English Medical literatures, such as surgical excision, laser therapy, infrared coagulation, cryotherapy and sclerotherapy.

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ALHE is characterized by persistent, recurrent dermal or subcutaneous nodules primarily in the hand and neck area. Although there is a predilec­tion for the periauricular area, involvement of other skin surfaces as well as the oral mucous membranes, pharynx, and orbital has been reported. The lesions, which are often pruritic or painful, may coalesce into confluent plaques that are chronic with little propensity for spontaneous resolution. In some cases, peripheral blood eosinophilia is present.

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A 24-year-old man presented with an asymptoma­tic firm single erythematous papule on the lower eyelid. The lesion had started as a tiny papule 1 year earlier, and enlarged slowly. There was no history of trauma to the eyelid. He had been taking medication for nephrotic syndrome due to mesan- gioproliferative glomerulonephritis for 5 years. The family history was noncontributory. Laboratory tests including blood cell count and blood chemistry were within normal limits. On physical examination, a single shiny firm erythematous 5-mm sized, round papule was noted on the right lower eyelid (Fig. 1). There were no palpable lymph nodes. Clinically, our differential diagnosis included dermatofibroma, keloid scar, or granuloma pyogenicum. The histopathologic examination revealed dense multiple lobular infil-trations of inflammatory cells with central vessels throughout the dermis. Inflammatory cells included many eosinophils and lymphocytes (Fig. 2A). Read More…