clinical-case-studies-cover

Progressive Ascending Telangiectasia

INITIAL PRESENTATION

A 49-year-old white female presented with widespread diffuse blue vessels on her lower extremities. The vessels appeared suddenly, 16 years after the birth of her third child. The vessels started on the feet and ankles, and progressed proximally over the years to her midthigh. The patient had no varicosities, no associated symptoms, and no lesions were present elsewhere on the body.

Physical examination revealed marked telangiectatic superficial vessels limited to the patient’s lower extremities. ( Figure 1A , 1B , and 1C ) Because of the distribution of lesions, initially limited to the feet and ankles and later spreading to the thighs, a diagnosis of progressive ascending telangiectasia (PAT) was made.

Figure 1A. Telangiectatic vessels originating on the patient’s foot and ankle.

Figure 1B. Telangiectatic vessels gradually ascending to the patient’s thigh.

Figure 1C. Telangiectatic leg vessels.

THERAPY

The patient initially had been treated with sclerotherapy with little improvement. Although ectatic vessels on the lower extremities are often resistant to treatment with the pulsed dye laser, the superficial, thin capillaries of PAT have been shown to be particularly responsive to laser and light therapy. The patient was treated with hundreds of pulses of the 595-nm pulsed dye laser at fluences of 7 to 7.5 J/cm2, 40/20 DCD, 10-mm spot, and pulse durations of 6 and 10 ms with a clinical endpoint of mild purpura and vessel thrombosis (Vbeam; Candela Corporation, Wayland, MA). She was instructed to wear support hose for 3 days after treatment. The treatment was well-tolerated, and the patient returned in 2 months with optimal results from areas treated with both of the two parameters that were used. ( Figure 2 ) She subsequently underwent three treatments 1 to 2 months apart with near complete vessel clearing on the feet, ankles, and legs, and with no adverse effects other than the expected mild purpuric response lasting approximately 10 days. ( Figure 3 ) Over 2000 pulses were required to cover the affected areas.

Figure 2. Good initial clearing of telangiectasia on the patient’s foot and ankle after one treatment with the pulsed dye laser.

Figure 3. Mild transient purpura immediately after treatment with the pulsed dye laser.

FOLLOW UP

The patient maintained good vessel clearance at 1 year follow-up with a small additional treatment performed at the same settings to clear scattered remaining vessels. (Figure 4)

Figure 4. Near complete clearance of leg veins after three treatments with the pulsed dye laser.

CONTRIBUTORS

Melissa A. Bogle, MD, Laser and Cosmetic Surgery Center of Houston, Houston, TX
Jeffrey S. Dover, MD, FRCPC, SkinCare Physicians, Chestnut Hill, Massachusetts; Section of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Dermatology, Dartmouth Medical School, Hanover, New Hampshire
Kenneth A. Arndt, MD, SkinCare Physicians, Chestnut Hill, Massachusetts; Section of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Dermatology, Dartmouth Medical School, Hanover, New Hampshire; Department of Dermatology, Harvard Medical School, Boston, Massachusetts

Search Derm101.com for telangiectasia.