Venous Lakes Treatment & Management

Updated: May 17, 2017
  • Author: Claudia Hernandez, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

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, 6] 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. [7]

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. [8]

Other visible-light lasers include the quasicontinuous wave lasers, such as copper vapor, krypton, and potassium-titanyl-phosphate (KTP) lasers. [9, 10, 11, 12, 13] 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. [14, 15] 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." [16]

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. [17] 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. [18] 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 two patients in one study. [19] Both patients needed two treatments for clearance, and no atrophy or scarring was noted after treatments.

Multiwavelength laser therapy (595-nm pulsed-dye and 1064-nm Nd:YAG) have been tried with some success since the combination of lasers helps reduce pulse duration and fluence. [20] However, the studies have been small and more are needed.

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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