Vascular lesions encountered in dermatology can be divided into
vascular malformations and vascular
tumors, namely infantile
hemangiomas (IH).
Vascular malformations can further be subdivided by their flow characteristics and vessel type. Slow, or low-flow lesions are either capillary
vascular malformations (CVMs), venous malformations, or lymphatic malformations. Fast, or high-flow lesions include an arterial component, and are categorized as
arteriovenous malformations. IH and CVMs are among the most common benign vascular lesions seen and treated in dermatology. CVMs are present at birth and grow as the individual does, whereas IH usually appear days to weeks later and may rapidly enlarge for a period of months to a year before gradually involuting. As the technology has evolved, early and often
laser treatment with the pulsed
dye 595-nm
laser has become our standard
therapy of choice. More recently, we have started more patients on combination
therapy for IH with the topical beta blocker
timolol. If left untreated, CVMs darken and thicken, making them increasingly difficult to successfully treat with
lasers. IH involute, sometimes resulting in fibrofatty, atrophic plaques. These individuals can undergo ablative fractional resurfacing with a fractional
CO2 laser to improve the texture and appearance of these lesions.