Treatment of angiokeratoma
What is an angiokeratoma?
It is a benign proliferation that contains dilated, thin-walled blood vessels and on its surface an epidermal hyperplasia (increase in the thickness of the outermost layer of the skin). They exist in solitary form or, more frequently, they occur together (multiple).
What do angiokeratomas look like?
They appear as papules (small over-elevations, like “pimples”) of 1-5 mm, purple, reddish or even black, with a shiny and smooth roof with/without flaking on top. It is common for them to appear in groups and in certain areas, such as the genitals. They are asymptomatic and can occasionally bleed from rubbing or spontaneously. It is usually only an aesthetic alteration, as they do not cause discomfort or pose any risk to health. Exceptionally, they can cause itching or burning sensation.
What types of angiokeratomas are there?
There are localized and diffuse forms. Among the former we find the following:
· Solitary papular angiokeratoma. A single lesion. It usually appears on the legs.
· Angiokeratomas of the scrotum and vulva (Fordyce type). They are often multiple.
· Neviform (congenital) circumscribed angiokeratoma. It usually forms a plaque composed of purplish papules, which appears unilaterally in a lower limb.
· Bilateral angiokeratomas of the fingers (Mibelli type). They can occur on both the hands and feet.
The diffuse form is known as angiokeratoma corporis diffusum, and is usually associated with metabolic disease, such as Fabry disease or fucosidosis.
Why do angiokeratomas appear?
The exact reason is unknown , although it is believed that increased venous pressure is a risk factor for suffering from them (venous insufficiency, postpartum…). They are more frequent in vascular disorders such as varicocele, venous malformations, or after trauma.
Are they very frequent?
Yes. They are very common in the general population, and more so with age (their incidence increases significantly after the age of 20). Although it is believed that they are more frequent in men, it is likely that this is only because their detection is easier in the male genital tract, since it has fewer nooks and crannies and covered parts.
Are angiokeratomas dangerous?
No. They have no potential for malignancy and are not contagious (even if there is sexual intercourse if they are in the genital area, there is no risk of contagion). Occasionally they can bleed from small traumas: neither does the blood that comes off them imply any contagion. The bleeding stops with local pressure.
How are they diagnosed?
In general, visual examination by the dermatologist is sufficient. Dermoscopy (magnifying glass with polarized light) can be useful. Very exceptionally, a biopsy and histological study can be carried out when there are doubts about other diagnoses.
How are angiokeratomas removed?
Removing them is completely optional, either for aesthetic reasons or because they cause bleeding. There are different methods, such as electrocoagulation. The two main drawbacks of this technique are that it requires local anesthesia (painful injection) and that it can leave scars due to the little control over the depth of penetration of the instrument. It is possible to remove them by laser: with a vascular target, such as pulsed dye; or with the CO2 laser, which allows them to be removed immediately and most of the time without the need for local anesthesia. Another advantage of the CO2 laser is that, due to its precision and superficial action, it allows a large number of lesions to be treated in a single session and that it coagulates bleeding, which vascular devices do not do. Vascular lasers (pulsed dye or Nd:YAG of 1064 nm) are useful as long as the anqueratoses do not have great hyperkeratosis on their surface, otherwise efficacy is lost.
REFERENCES
Bechara FG, Jansen T, Wilmert M, Altmeyer P, Hoffmann K. Angiokeratoma Fordyce of the glans penis: combined treatment with erbium: YAG and 532 nm KTP (frequency doubled neodynium: YAG) laser. J Dermatol. Nov 2004; 31(11):943-5.