Venous Lakes Clinical Presentation

  • Author: Claudia Hernandez, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 23, 2012
 

History

Venous lakes most commonly occur in adults older than 50 years with a history of long-term sun exposure. The typical presentation is a slow-growing asymptomatic lesion. Patients with venous lakes may report that the papule has been present for several years prior to presentation. Recurrent bleeding after minor trauma may also be reported.

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Physical

Physical examination usually reveals a soft, compressible, dark-blue or violaceous papule (slightly elevated lesion), up to 1 cm in diameter. Venous lakes usually are well demarcated, with a smooth surface. Compression often causes a emptying of the blood content. Venous lakes typically are distributed on the sun-exposed surfaces of the face and neck, especially on the helix and antihelix of the ear and the posterior aspect of the pinna, as shown in the image below. Another common site of involvement is the vermilion border of the lower lip, shown below. Sometimes, several lesions are found on the same person, and the surrounding skin reveals actinic damage, as shown below.

Venous lake on the helix of the ear. Venous lake on the helix of the ear. Venous lake on the lower lip. Venous lake on the lower lip. Venous lake of the lip. Note the apparent actinic Venous lake of the lip. Note the apparent actinic damage of the surrounding skin. Courtesy of Albert C. Yan, MD.
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Causes

Two main theories regarding the development of venous lakes have been proposed. The first involves injury to the vascular adventitia and the dermal elastic tissue due to long-term solar damage permitting dilatation of superficial venous structures. The second theory involves the involvement of vascular thrombosis in the development of venous lakes. Thrombosis is commonly present in lesions of this type; however, whether the thromboses is a primary or a secondary event in the development of these lesions is unclear.

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Contributor Information and Disclosures
Author

Claudia Hernandez, MD  Assistant Professor, Department of Dermatology, University of Illinois at Chicago College of Medicine

Claudia Hernandez, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Chicago Dermatological Society, Chicago Medical Society, Dermatology Foundation, National Hispanic Medical Association, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Timothy McCalmont, MD  Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Apsara Consulting fee Independent contractor

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Jining Wang, MD, and Kim Wang, MD, to the development and writing of this article.

References

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  11. Roncero M, Canueto J, Blanco S, Unamuno P, Boixeda P. Multiwavelength Laser Treatment of Venous Lakes. Dermatol Surg. Nov 3 2009;[Medline].

  12. Bekhor PS. Long-pulsed Nd:YAG laser treatment of venous lakes: report of a series of 34 cases. Dermatol Surg. Sep 2006;32(9):1151-4. [Medline].

  13. Jay H, Borek C. Treatment of a venous-lake angioma with intense pulsed light. Lancet. Jan 10 1998;351(9096):112. [Medline].

  14. del Pozo J, Pena C, Garcia Silva J, Goday JJ, Fonseca E. Venous lakes: a report of 32 cases treated by carbon dioxide laser vaporization. Dermatol Surg. Mar 2003;29(3):308-10. [Medline].

  15. Wall TL, Grassi AM, Avram MM. Clearance of multiple venous lakes with an 800-nm diode laser: a novel approach. Dermatol Surg. Jan 2007;33(1):100-3. [Medline].

  16. Alcalay J, Sandbank M. The ultrastructure of cutaneous venous lakes. Int J Dermatol. Dec 1987;26(10):645-6. [Medline].

  17. Goldberg LH, Altman AR. Venous lakes of the ears. Cutis. Dec 1985;36(6):472-5. [Medline].

  18. Requena L, Sangueza OP. Cutaneous vascular anomalies. Part I. Hamartomas, malformations, and dilation of preexisting vessels. J Am Acad Dermatol. Oct 1997;37(4):523-49; quiz 549-52. [Medline].

 
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Venous lake on the helix of the ear.
Venous lake on the lower lip.
Venous lake of the lip. Note the apparent actinic damage of the surrounding skin. Courtesy of Albert C. Yan, MD.
Venous lake becomes inconspicuous during diascopy with a glass slide.
 
 
 
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