Venous Lakes Treatment & Management

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

Medical Care

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

  • 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.
  • 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.[13] 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.[14] 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.[15] 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

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

  • Diet is not relevant to the development of venous lakes.
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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

  1. Bean WB, Walsh JR. Venous lakes. AMA Arch Derm. Nov 1956;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. Jun 2004;42(3):251-3. [Medline].

  3. Colver GB, Hunter JA. Venous lakes: treatment by infrared coagulation. Br J Plast Surg. Sep 1987;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. Apr 2003;29(4):425-8. [Medline].

  5. Suhonen R, Kuflik EG. Venous lakes treated by liquid nitrogen cryosurgery. Br J Dermatol. Dec 1997;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. Mar 1990;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. Nov 2003;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. Jan 1984;73(1):78-83. [Medline].

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

  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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