Vascular conditions: differential diagnosis

Differential diagnoses of conditions including strawberry naevus, spider naevus, cherry haemangioma and telangiectasia.

Strawberry naevus
Strawberry naevus

Strawberry naevus

Presentation

  • Usually occurs on face in first few weeks after birth, in 3-5% of babies
  • 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 after 10 years
  • Treatment options, when required, include propranolol, intralesional steroids, interferon or imiquimod

Spider naevus

Spider naevus

Presentation

  • Localised telangiectasia arising from one central vessel
  • Found in distribution of superior vena cava; on hands in young children
  • Occurs in 10-15% of healthy children and adults; can be more common in pregnancy
  • 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, treating liver may lead to regression
  • If treatment required, electrocautery or laser can be helpful
  • Treatment should be aimed at the central vessel

Cherry haemangioma

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 torso, where they are often multiple, called Campbell de Morgan spots
  • Usually small, but may be up to 1cm diameter

Management

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

Telangiectasia

Insect bite

Presentation

  • Small dilated blood vessels near surface of skin, 0.5-1mm diameter
  • Can also occur on mucous membranes
  • Can develop anywhere, but most commonly seen on face
  • Multiple causes; in this case, following radiotherapy

Management

  • Treatment not usually required
  • When occurring on lower leg, 88% associated with underlying venous reflux disease
  • Treatment includes lasers or localised sclerotherapy
  • Extensive camouflage can be helpful
  • Dr Nigel Stollery is a GP in Leicestershire

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