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Venous Lakes Treatment & Management

  • Author: Claudia Hernandez, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Mar 19, 2014
 

Medical Care

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  • Venous lakes are nonproliferative vascular lesions that are not treatable via medical means.
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Surgical Care

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  • Surgical biopsy or excision can be useful for confirmation of the diagnosis or for venous lake removal. Treatment usually is performed for cosmetic reasons or to alleviate recurrent bleeding.
  • Surgical treatment by cryosurgery, electrosurgery, sclerotherapy, and excision have all been reported to be successful forms of therapy for venous lakes.[2, 3, 4, 5] Although all of these approaches are economical, multiple treatments may be necessary. Treatment of venous lakes may be complicated by prolonged bleeding, swelling, pain, textural changes in treated areas, and scarring.
  • The use of the argon laser and infrared coagulator has required up to 10-14 days for resolution of crusting and eschar formation. A tendency for scar formation with these therapies has been reported in the literature.[6]
  • Using the theory of selective photothermolysis, dermatologic laser surgeons have effectively used visible-light lasers such as the flashlamp pulsed dye laser at carefully chosen wavelengths, pulse durations, and doses to selectively destroy blood vessels, minimizing injury to the surrounding healthy skin. Numerous treatments may be necessary with this laser to clear the venous lake. Although scarring does not appear to be common with this laser, bleeding may occur after venous lake treatment.[7]
  • Other visible-light lasers include the quasicontinuous wave lasers, such as copper vapor, krypton, and potassium-titanyl-phosphate (KTP) lasers.[8, 9, 10, 11] These lasers carry a slightly higher risk of scarring compared with the pulsed dye laser.
  • One study reported a series of 34 patients responding well to long-pulsed Nd:YAG laser, with 94% of the lesions clearing completely with one treatment and no complications reported.[12] The high rate of success is attributed to the deep-penetrating 1064-nm wavelength and the longer pulse widths, which damage larger vascular structures. Authors of a recent review article stated in their experience between pulsed dye laser, intense pulsed light, and Nd:YAG, the long-pulsed Nd:YAG laser was "superior to achieve fast and safe results."[13]
  • A single case report describes intense pulse light source treatment with a cool thermocoupling gel to protect the epidermis. This approach has been efficacious and, similar to the visible-light lasers, requires no anesthesia. No purpura or crusting and no visible scarring were observed at 1-month follow-up visits.[14] Because only one case report has been published, more studies are needed prior to making conclusions about the effectiveness of this modality for venous lakes.
  • Vaporization with infrared lasers (eg, carbon dioxide laser) has been effective. One study reported that on average, only one session was needed to treat venous lakes, and the postoperative crusting resolved after 7-10 days.[15] Unlike visible-light lasers, local anesthesia is needed when venous lakes are treated with a carbon dioxide laser. Scarring, including pigmentary and textural changes, is thought to be more likely with carbon dioxide lasers compared with visible-light lasers.
  • An 810-nm diode laser was used on 2 patients in one study.[16] Both patients needed 2 treatments for clearance, and no atrophy or scarring was noted after treatments.
  • With continuing advances in the technology of new lasers and intense pulsed light sources, excellent results with reduced costs, minimal pain, minimal postoperative care, and scarring will be available to an increasing patient population.
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Consultations

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  • Consultation with a dermatologist is usually appropriate for confirmation of the clinical diagnosis of venous lakes.
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Diet

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  • Diet is not relevant to the development of venous lakes.
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Contributor Information and Disclosures
Author

Claudia Hernandez, MD, FAAD Associate Professor, Director of Dermatological and Clinical Studies, Department of Dermatology, University of Illinois at Chicago College of Medicine; Attending Physician, University of Illinois at Chicago Hospital

Claudia Hernandez, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Association for Cancer Research, Association of Professors of Dermatology, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Society for Pediatric Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman 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, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Acknowledgements

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

References
  1. Bean WB, Walsh JR. Venous lakes. AMA Arch Derm. 1956 Nov. 74(5):459-63. [Medline].

  2. Ah-Weng A, Natarajan S, Velangi S, Langtry JA. Venous lakes of the vermillion lip treated by infrared coagulation. Br J Oral Maxillofac Surg. 2004 Jun. 42(3):251-3. [Medline].

  3. Colver GB, Hunter JA. Venous lakes: treatment by infrared coagulation. Br J Plast Surg. 1987 Sep. 40(5):451-3. [Medline].

  4. Kuo HW, Yang CH. Venous lake of the lip treated with a sclerosing agent: report of two cases. Dermatol Surg. 2003 Apr. 29(4):425-8. [Medline].

  5. Suhonen R, Kuflik EG. Venous lakes treated by liquid nitrogen cryosurgery. Br J Dermatol. 1997 Dec. 137(6):1018-9. [Medline].

  6. Neumann RA, Knobler RM. Venous lakes (Bean-Walsh) of the lips--treatment experience with the argon laser and 18 months follow-up. Clin Exp Dermatol. 1990 Mar. 15(2):115-8. [Medline].

  7. Polla LL, Tan OT, Garden JM, Parrish JA. Tunable pulsed dye laser for the treatment of benign cutaneous vascular ectasia. Dermatologica. 1987. 174(1):11-7. [Medline].

  8. Boffa MJ. Pulsed dye laser treatment of thick/raised vascular lesions using compression with clear plastic. J Am Acad Dermatol. 2003 Nov. 49(5):879-81. [Medline].

  9. Landthaler M, Haina D, Waidelich W, Braun-Falco O. Laser therapy of venous lakes (Bean-Walsh) and telangiectasias. Plast Reconstr Surg. 1984 Jan. 73(1):78-83. [Medline].

  10. Ross BS, Levine VJ, Ashinoff R. Laser treatment of acquired vascular lesions. Dermatol Clin. 1997 Jul. 15(3):385-96. [Medline].

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

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

  13. Bencini PL, Tourlaki A, De Giorgi V, Galimberti M. Laser use for cutaneous vascular alterations of cosmetic interest. Dermatol Ther. 2012 Jul-Aug. 25(4):340-51. [Medline].

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

  15. 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. 2003 Mar. 29(3):308-10. [Medline].

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