Cutaneous Vascular Anomalies - Arteriovenous Fistula

Arteriovenous Fistulas are benign cutaneous vascular anomalies that I occasionally encounter in both my The Woodlands dermatology and Conroe dermatology offices.  An Arterovenous Fistula forms when a connection is made between an artery and a vein and the normal capillary bed that blood diffuses through under low pressure is bypassed.  Arteriovenous Fistulas may be acquired later in life or present congenitally.  They most common site of an acquired Arteriovenous Fistula is on the extremities as a result of trauma or intentionally done surgically to create dialysis access.  The skin over an Arteriovenous Fistula is usually very warm with excess hair growth and may have a red/purple appearance.  Sometimes the affected extremity may be larger than its counterpart.  Treatment of Arteriovenous Fistulas is usually through excision. 

 Arteriovenous Fistula (http://images.ddccdn.com/cg/images/en1294416.jpg)

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Cutaneous Vascular Anomalies - Nevus Flammeus

Nevus Flammeus is a very common cutaneous vascular anomaly that I routinely encounter in both my The Woodlands dermatology and Conroe dermatology offices.  Also called a port wine stain or a "stork bite,"  Nevus Flammeus clinically appears as a pink/red patch on the posterior neck that occurs at birth.  It is present in 5% of the population and is composed of capillaries.  It can also be found on the forehead in some patients.  Usually, a Nevus Flammeus remains flat but it can occasionally become warty and elevated above the skin.  In some patients, a Nevus Flammeus may appear on the face in the area over the eye innervated by V1 branch of the trigeminal nerve and the Sturge-Weber Syndrome may manifest in which these patients develop epilepsy, mental retardation, hemiplegia, and ocular defects.  Treatment of Nevus Flammeus can usually be accomplished with a pulse dye laser.

http://dermis.multimedica.de/bilder/CD181/550px/img0039.jpg

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Cutaneous Vascular Anomalies - Angiokeratomas

Angiokeratomas are benign cutaneous vascular anomalies that I encounter on a daily basis in both my The Woodlands dermatology and Conroe dermatology offices.  Angiokeratomas are vascular malformations of veins and capillaries in the dermis and subcutaneous tissues.  Clinically, Angiokeratomas appear as a blue/red papule.  They are most commonly found on the legs but also can appear on the scrotum, arms and trunk.  Treatment of Angiokeratomas involves excision, cryosurgery, laser, electrocautery; however, whatever the chosen treatment modality there is still a high recurrence rate.

Angiokeratomas (http://www.fabrynetwork.org/~fabry/sites/default/files/example-of-angiokeratomas_0.jpg)

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Molluscum Contagiosum

Molluscum Contagiosum is one of the more common skin diseases I encounter in both my The Woodlands dermatology and Conroe dermatology offices. It is a poxvirus that is spread by direct skin to skin contact, especially wet skin. Swimming pools are a common place where the infection is transmitted. There are four types of Molluscum virus MCV-1, MCV-2, MCV-3, MCV-4. Most all cases are caused by MCV-1 and patients with HIV are most commonly infected with MCV-2. Unlike HPV, the different types of MCV are almost clinically identical and can infect any anatomic region of the body. Molluscum is mainly found in children but can be seen in immunosuppressed patients and sexually active adults. The lesions of Molluscum are small flesh colored papules with a characteristic central umbilication. Occasionally, eczema forms around Molluscum, which appears as a red scaly itchy rash. It is important to treat all of the lesions as they can spread to other parts of the body via auto inoculation. I treat most of my patients who have Molluscum with liquid nitrogen. Most patients are cured in one or two visits. Unlike warts, Molluscum does not lay dormant but can be completely eradicated. In some patients, topical treatments such as Aldara or tretinoin cream can be used but these take much longer to work and may not have any efficacy in some patients. In young children who cannot tolerate cryotherapy, the parents can perform a modified incision and drainage at home. The Molluscum are cleansed with isopropyl alcohol and a sterile diabetic needle is used to open the top of the lesion. Duct tape is applied to the lesion and as it is pulled away, the central infectious core is extracted on the tape.

Molluscum (http://www.aad.org/Image%20Library/For%20the%20Public/Dermatology%20A%20-%20Z/molluscum-contagiosum-skin-bumps.jpg?code=a1ccd5c0-389e-485d-a1c0-93c189c0ae94)

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Cutaneous Vascular Anomalies - Nevus Anemicus

Nevus Anemicus is a benign cutaneous vascular anomaly that I encounter in both my The Woodlands dermatology and Conroe dermatology offices.  Nevus Anemicus begins at birth and is an area of skin that is paler than the surrounding skin.  It usually has an irregular shape and is rather well defined.  When the areas of skin surrounding it become flushed, the Nevus Anemicus becomes more apparent.  It may be mistaken as vitiligo but Nevus Anemicus has a normal amount of melanin.  The etiology of Nevus Anemicus is that the blood vessels in this area are very sensitive to the circulating catecholamines.  There is no treatment for Nevus Anemicus.

Nevus Anemicus (http://dermis.multimedica.de/bilder/CD050/550px/img0070.jpg)

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