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INTRODUCTION

Facial telangiectasias are dilated vessels appearing superficially in the dermis mostly on the alae nasi. Telangiectasias are also common in scars and various skin lesions.

EPIDEMIOLOGY

Incidence: very common

Age: most common in adults and elderly people

Sex, race: no sex or race predisposition

Precipitating factors: chronic actinic damage, rosacea, and topical steroid use are the most common precipitating factors. Other less common etiologies include hereditary hemorrhagic telengiectasia, Cockayne syndrome, ataxia telengiectasia, Bloom’s syndrome, Rothmund–Thomson syndrome, scleroderma, CREST syndrome, lupus, and radiation dermatitis

PHYSICAL EXAMINATION

Telangiectasias consist of fine, tiny, erythematous linear vessels, typically 0.2 to 2 mm in diameter, coursing along the surface of the skin, which blanch easily upon pressure.

DERMATOPATHOLOGY

Dilated, thin-walled vessels in the upper dermis.

COURSE

Facial telangiectasias are usually chronic in nature with no spontaneous resolution.

MANAGEMENT

Facial telangiectasias are frequently treated for cosmetic purposes. Multiple effective treatment options exist.

  • Laser treatment: multiple effective options are available. Patients must be aware that over time they are likely to develop more telangiectasias.

    • – Pulsed dye lasers (PDL) are the treatment of choice for facial telangiectasias (Figs. 36.136.5).

Figure 36.1

(A) Middle-aged male with multiple facial telangiectasias. (B) Purpura observed immediately after pulsed dye laser treatment. (C) Significant reduction in telangiectasias after a single-pulsed dye laser treatment

Figure 36.2

(A) Telangiectasias prior to pulsed dye laser treatment. The setting was 10-mm spot, 595 nm, 8 J/cm2, 6-ms pulse duration. (B) Immediately posttreatment. (C) Ten days after pulsed dye laser treatment

Figure 36.3

(A) Female with centrofacial telangiectasias and erythema prior to pulsed dye laser therapy. (B) Pulsed dye laser treatment at a wavelength of 595 nm, 10-ms pulse duration, 7 J/cm2, 7-mm spot size. (C) Appropriate clinical endpoint of erythema and slight edema at sites of treatment. No purpura was produced

Figure 36.4

Telangiectasias prior to long pulse-duration pulsed dye laser treatment. The settings were 40-ms pulse duration, 7-mm spot, 595 nm, 12J/cm2. (B) Note the transient vasoconstriction with almost complete disappearance of the telangiectasias immediately posttreatment. (C) Slight decrease in diameter of the telangiectasias 1 month after one treatment

Figure 36.5 (A)

Large caliber nasal telangiectasias on the nose prior to long-pulse duration pulsed dye laser treatment. (B) Decrease ...

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