Spider
angiomas
are acquired vascular
lesions. They are named
after their manifestation
and have a spider-like formation and look to them.
Since they have a bearing on one’s
appearance there is a
large demand for the
cosmetic laser correction
of this visually scarring
condition.
These types of angiomas
are different from congenital
vascular lesions and malformations.
Apart from the spider and
cherry angiomas, acquired
vascular lesions include
telangiectases, pyogenic,
granuloma, venous lake
and leg vein abnormalities.
These vasculatures are
marked by varying extent
of blood vessel ectasia.
Selective
photothermolysis is the
fundamental practice in
the treatment of these
acquired lesions, which
includes cherry and spider
angiomas as well. This
methodology first originated
in the 1980s and since
then various types of lasers
and light sources have
been effectively administered
in the treatment of vascular
lesions like
spider angiomas. Some of
the most common treatment
methods include:
- Wavelengths
between green and yellow
- Near
infrared lasers
- Broadband
light sources
Though these have certain
drawbacks, they form the
standard treatment procedures
for vascular lesions. However,
the treatment of acquired
vascular lesions is mostly
optional, congenital forms
must be detected and treated
early. Spider angioma and
cherry or strawberry angiomas
are commonly acquired lesions
and respond well to laser
corrections.
The clinical
characteristics of spider
angioma
The spider-like formation
in this type of angioma
is caused by a focal arteriole
that superficially branches
out like in the tentacles
of a spider. The main arteriole
is an abnormal segment
of the superficial vascular
plexus that is directly
linked with enlarged superficial
tubular appendages. The
tubular diameter is around
0.1–0.5 mm.
The spread of the lesion
is generally in singular
forms and occur in the
face, neck, chest, and
other areas of the body
that are tanned by the
sun. Multiple formations
occur in liver diseases
or HHT.
Treatment of spider angioma
The laser treatment of
spider angioma is a two-pronged
process that involves:
- Closure of the main
supplying arteriole
- Successive correction
of the superficial
offshoots that branch
out from
the
focal arteriole
The depth of the vasculature
that is to be corrected
is roughly 300 microns.
The method used is diascopy
that plugs the supply to
focal arteriole. After
the diascopy, one or two
single laser pulses are
administered to the spot,
combined with a top up
to the superficial branches.
This makes these branches
ready for laser application.
Each and every branch should
be laser treated to prevent
relapse.
The standard PDL devices
are ideal for the central
arteriole, since the resultant
scarring is limited to
a restricted area. Pulsed-dye
laser treatment also shows
effective results but with
the following settings:
- Fluences between 8
and 10 J/cm2
- Spot
size of 5- or 7-mm
- Dynamic cooling device
(DCD) settings of 30–40/20–30
The first laser application
may be followed up by another
session in some cases.
Whether more laser sessions
are required should be
adjudged after 4–6
weeks of the first laser
treatment.
