Differential diagnoses: Vascular conditions

Dr Nigel Stollery compares the presentation and management of four vascular conditions.

Strawberry naevus

Presentation

  • Usually occurs in the first few weeks after birth
  • Common condition, affecting 3-5% of babies
  • Three times more common in females
  • Most commonly occurs on the face
  • Begins flat, then develops raised strawberry-like areas
  • Growth may continue for three to four years until regression
  • Where large and affecting blood flow to limbs, growth may be affected
  • Head and neck lesions may affect vision and breathing

Management

  • If diagnosis is in doubt, MRI or ultrasound can be helpful
  • Treatment not usually required
  • Full regression usually complete after 10 years
  • Treatment options when required include propranolol, intralesional steroids, interferon or imiquimod

Spider naevus

Presentation

  • Localised telangiectasia arising from one central vessel
  • Found in the distribution of the superior vena cava
  • Also found on the hands in young children
  • Occurs in 10-15% of healthy children and adults
  • Where more than three present, may be a sign of liver disease

Management

  • Treatment not usually required
  • May regress spontaneously
  • If associated with liver disease, treatment of the liver problem may lead to regression
  • If treatment is required, electrocautery or laser treatment can be helpful
  • Treatment should be aimed at the central vessel

Cherry haemangioma

Presentation

  • Cherry red papules associated with underlying abnormal proliferation of blood vessels
  • Colour ranges from bright red to purple
  • Common benign lesions, especially on the torso, where they are often multiple, called Campbell de Morgan spots
  • Usually small, but may be up to 1cm in diameter

Management

  • Treatment rarely required and may result in scarring
  • Recurrent trauma can lead to troublesome bleeding
  • Options include electrocautery, excision and lasers

Telangiectasia

Presentation

  • Small dilated blood vessels near the surface of the skin
  • 0.5 to 1mm in diameter
  • Can also occur on mucous membranes
  • Can develop anywhere, but most commonly seen on the face
  • Multiple causes. In this case, they followed radiotherapy

Management

  • Treatment not usually required
  • When occurring on the lower leg, 88% associated with underlying venous reflux disease
  • Treatment includes lasers or localised sclerotherapy
  • Extensive camouflage can be helpful

Dr Stollery is a GPSI in dermatology in Kibworth, Leicestershire

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