Angiomas are commonly called various vascular abnormalities affecting about 10% of the pediatric population as well as vascular abnormalities affecting the adult (ruby angiomas, stellate angiomas …).
These vascular anomalies can affect all types of vessels: capillaries, veins, arteries, lymphatic vessels
Angiomas most often have a red, bluish or purple ball appearance on the skin or lifting the skin. Sometimes small purplish vessels called telangiectasia can be observed.
Sometimes the angiomas can be hot, even pulsatile (we feel the heartbeat, which means they have an arterial component).
We will distinguish the angiomas of the infant and the adult:
The most common forms are infantile hemangioma and angioma
Infantile hemangioma is a vascular tumor that appears in the first weeks of life , sometimes preceded by the birth of a clear sheet (anemic nevi) or telangiectasia in a pool.
The most classic form is the ” strawberry “, a superficial form of the hemangioma consisting of a red-purplish tumor placed on the skin, with sharp edges and a slightly irregular surface called “mammillated”.
There is also a deep form of hemangioma consisting of a normal or bluish color of the skin and a mixed form of superficial and deep forms.
The hemangioma then evolves most often in three phases :
- it increases in size and volume until about 6 months
- it is then stable during the second half of life
Then it tends to regress most often in a few years . However, there are more or less significant sequelae in 70% of the cases where the angioma was: fibro-adipose residues, finer skin areas, telangiectasia .
It is most often located and measures a few centimeters, but doctors will be alerted by a hemangioma of more than 5 cm² on the face of the infant, especially in the frontal or palpebral zone because they can be associated with a malformation syndrome called PHACES, of English acronym: posterior fossa anomalies of the brain, facial hemangioma, intra and extra-cranial arterial abnormalities, congenital cardiac anomalies and aortic coarctation, ocular abnormalities (eye), sternal and ventral abnormalities
The plane angioma, classically called ” wine stain ” is a tablecloth generally of red – purplish color more common on the face, but can be seen all over the body.
Unlike the hemangioma, it is present from birth and spreads gradually during the growth of the child.
It can be associated with rare malformative syndromes notably in case of involvement of the limbs (Klippel-Trenaunay syndrome, associating a plane angioma and a gigantism of a limb)
Angiomas of the adult
Small, purplish telangiectatic zone in the form of a star, frequent on the face or the torso, which can regress spontaneously.
In case of large number of lesions, the doctor can look for a pregnancy or even a liver problem
Small balls of wine color placed on the skin, very common after the fifties
Given the regression of the majority of infantile hemangiomas, the rule is to monitor the hemangioma in about 80% of cases. However, it may be useful to treat in case of localization at risk (throat, near the eye, mouth), ulceration, major aesthetic risk … It is then most often used a beta-blocker called propranolol , whose trade name is Hemangiol, established in a pediatric hospital because of its cardiovascular risks and hypoglycemia in particular. Then, if tolerance is good for the infant, the treatment is continued at home for about 6 months orally during meals.
On the other second-line treatment can be offered in case of resistance or poor tolerance to propranolol: interferon, corticosteroids intravenously or by injection into the hemangioma, vincristine, laser …
The treatment of the planar angioma is most often performed by means of a vascular laser, typically as early as possible in life. It takes on average 3 sessions to mitigate the injury.
Angiomas of the Adult
In case of desire of the patient, it is possible to coagulate with electrocautery or vascular laser.