What are Telangiectasias
Telangiectasias are harmless dilations of small blood vessels (venules, capillary arterioles), visible beyond the epidermis. Telangiectasias appear as superficial sinuous arborescences, with a bluish-red color, often the consequence of cutaneous disorders of an inflammatory degenerative nature: not surprisingly, telangiectasias represent a frequent disorder in dermatoses.
Origin of the term
The etymology of the term "teleangectasia" is curious, which derives from the name attributed by the ancient Greeks to a visible lesion of the small blood vessels. Telos (fine), angeion (vase), ektasis (dilatation), or lesion / dilation of the end of the vessel = tele-ang-ectasia .
Incidence
Telangiectasias occur in men and women, with a female propensity; in general, the disorder is related to advancing age, but there are also cases of people suffering from telangiectasias at a young age. In senescence, telangiectasias tend to be more evident: in fact, if in the young subjects the diameter of the affected blood vessels is between 2 and 3 millimeters, in the elderly the dimensions may increase to be associated with cerebral, pulmonary or arteriovenous fistulae. heart. Telangiectasias present a variable course over the years: their number and size may not only change, but the appearance of new telangiectasias is very likely.
Features
Telangiectasias manifest themselves as microvaric that can take different forms: linear, circular, reticular, tufted, spotted or spider-web (in this regard, telangiectasias can be confused with spider angiomas). Similarly, telangiectasias can take on different colors ranging from purple to blue and red. Furthermore, they may appear in slight relief (papules), with or without arborization (branched arrangement of the vessels).
Lesions can affect not only the epidermis, but also the mucous membranes; they generally appear small, especially at the level of the face. Specifically, telangiectasias are often localized on the inner surface of the lips, in the nasal and lingual mucosa, on the gums, on the auricles, on the palate; sometimes, even the trunk, nails, fingers, soles of the feet and the palms of the hands can be affected.
Symptoms
Telangiectasias are normally asymptomatic venous malformations: vascular alterations that do not result in any symptoms or pathological effects, despite involving an evident alteration of the appearance of the skin. In addition to this, sometimes, telangiectasias could cause itching, in these cases, it is better not to underestimate them and contact the doctor in order to exclude the presence of any pathologies not yet diagnosed.
In other cases, on the other hand, telangiectasias are related to bleeding, particularly if the lesions - of a serious nature - affect the skin, mucous membranes and digestive system; nevertheless, it is very unlikely that such bleeding will cause death. If the bleeding recurs over time, and occurs with a certain frequency, the affected subject could still present an anemic (iron deficiency) even severe form.
Causes
The causes that favor the appearance of telangiectasias can be multiple: vasodilation, repeated inflammatory processes, genetic predisposition, hormonal variations (eg pregnancy) and atrophy of skin tissues, all contribute to delineate the etiopathological picture of telangiectasias.
However, in most cases, telangiectasias represent the direct consequence of a vasodilation caused by a difficult and inadequate venous drainage.
Classification
Based on the clinical picture of telangiectasias, we distinguish:
- Telangiectasias caused by venous insufficiency : related to slowing of venous blood flow, and to varicose veins (affecting the feet, legs and thighs).
- Teleangectasias due to hormonal alterations : a typical disorder of pregnant women, menopausal women or those taking the contraceptive pill (they mainly affect the thighs).
- Varicose-reticular telangiectasias : they often represent the symptoms of venous insufficiency.
- Telangiectasias caused by capillary weakness : determined by excessive heat or cold, UV rays (mainly affect the legs).
- Teleangectasis matting : telangiectasias occur as a result of surgical interventions or following the injection of sclerosing substances. In general, they regress in a few months and there is no need for resolving therapies.
Finally, there are particular types of telangiectasias caused by genetic causes: this is the case of Osler-Rendu-Weber t elangectasia or hereditary haemorrhagic telangiectasia .
Osler-Rendu-Weber disease is an autosomal-dominant genetic transmission disease, with lesions related to the multi-organ alteration of blood vessels; it therefore affects many organs, such as the liver, the brain, the skin, the lungs and the gastro-enteric apparatus. It is generally manifested by epitaxis (bleeding from the openings of the organism, an externalized hemorrhage originating from within).
The underlying cause of hereditary haemorrhagic telangiectasias is represented by the mutation of three genes (Endoglina, ALK1, SMAD4). The alteration of the genes involves the manifestation of telangiectasias: according to the affected gene, the telangiectic manifestation will present some clinical differences. There are no solution therapies, since it is a genetic disease; in spite of this, some therapies are identified to lighten the psychological and physical disorders that derive from it (use of drugs that counteract blood loss, embolization techniques to prevent the dramatic progression of the pathology, hydration and mucosal hygiene, laser therapy) .
Diagnosis
Associated pathologies
In some cases, telangiectasias can occur in association with various diseases, of which they are sometimes one of the main symptoms. Among these, we recall:
- Couperose ;
- Rosacea ;
- Scleroderma ;
- Actinic keratosis ;
- Ataxia-telangiectasia (or Louis-Bar syndrome), a genetic disease characterized by the formation of oculo-cutaneous telangiectasias associated with immunodeficiency and cerebral ataxia;
- Xeroderma pigmentoso ;
- Sturge-Weber syndrome, a rare congenital neurocutaneous disease that is characterized by the formation of small blood vessels in the face and eyes;
- Bloom syndrome, a rare genetic chromosomal rupture disorder that is characterized by growth retardation and the appearance of telangiectatic facial rashes;
- Klippel-Trenaunay-Weber syndrome (or angio -osteo-hypertrophic syndrome), a rare congenital disease characterized by malformations of the blood vessels of a limb.
Treatment
Of course, the treatment to be carried out depends on the type of telangiectasia that the patient suffers from and, above all, on the cause that triggered them.
Therefore, if the telangiectasias represent the symptom of some basic disease, the treatment must be directed to the cure of the primary disorder that gave rise to these microvaricas.
Some affected individuals, after consulting a doctor, use laser therapy, one of the most successful treatments for the elimination of telangiectasias. In addition to the laser, it is also possible to resort to treatments with high intensity pulsed light, with radiofrequency, or to sclerotherapy.
The most serious consequence derived from telangiectasias is related to the epitaxis; in this regard, the treatment includes infilling, electrocoagulation, embolization and use of topical haemostatics, which represent possible measures to stop bleeding.
Considering, then, that in some subjects the loss of blood is of such consistency as to cause anemia and iron deficiency, blood transfusion and iron supplementation is sometimes appropriate.
Summary
To fix the concepts ...
| Disease | Telangiectasia |
| Origin of the term | From ancient Greek: Telos (fine), angeion (vase), ektasis (dilatation): lesion of the end of the vessel, tele-ang-ectasia . |
| Clinical picture | Asymptomatic venous malformations: linear, circular, reticular microvaric, often related to hemorrhages of varying degrees |
| Causes | Vasodilation, inflammation, hormonal changes, tissue atrophy, genetic predisposition |
| Classification |
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| Associated pathologies |
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| Location | Face (lips, forehead, auricles, nasal and lingual mucous membranes, gums), trunk, nails, fingers, internal organs |
| Incidence | Especially men and women after their thirties |
| Diagnosis | Multiple telangiectal lesions, bleeding, progression of the sores over time |
| Telangiectasias: possible therapies | Infills, electrocoagulation, embolization, use of topical haemostatics, laser therapy, high intensity pulsed light, radiofrequency, sclerotherapy. |
