Tuesday, June 17, 2014

"Broken Capillaries"- what the what and also why?

Ever wonder where those unsightly lacy threads on your skin came from? Or why applying creams and treatments to make them disappear do exactly diddly squat? Often called broken capillaries, telangiectasia is the official name for those pesky little marks.

In this post we'll be discussing pathogenesis/etiology, prognosis, and treatment. So sit back, grab a cup of coffee, and get ready for some science to fly at ya'.

What exactly are broken capillaries?

First things first- technically broken capillaries aren't actually 'broken'. Colloquially known, 'broken capillaries' are clinically known as a telangiectasia. Telangiectasia are small, widened blood vessels on the skin- they're the permanent dilatation of superficial blood vessels in the skin and may occur as isolated phenomena or as part of a generalized disorder. Broken or bleeding capillaries are known as petechiae and they can happen after periods of intense coughing or vomiting. Moreover, petechiae tend to heal up and disappear over time- telangiectasia don't. They can develop anywhere on the body. Most often they are seen in the skin (like on your face or your legs), mucous membranes, and the whites of your eyes. Occasionally telangiectases bleed and cause issues, like if they occur in the brain and cause problems due to said bleeding. However, telangiectases are typically harmless.

The causes of telangiectases are multifactorial, however, exact etiology/pathogenesis isn't known. What is known are behaviors/medical conditions that can lead to them. These include: alcoholism (as it can affect the flow of blood in the vessels- also frequent vomiting can cause telangiectases due to the pressure exerted), aging (blood vessels begin to weaken; the development of spider veins (telangiectases) may occur at any age but usually occurs between 18 and 35 years furthermore telangiectases appear to peak in frequency/appearance between the ages of 50 and 60), chemotherapy, exposure to extreme cold (like when skiing), extreme temperature changes (like with hot showers or saunas), gender (women tend to be afflicted with telangiectases more frequently than men), genetics, lifestyle (prolonged sitting or standing in daily activities/occupation can lead to increased risk of developing telangiectases in the legs), pregnancy (can apply large amounts of pressure on venules), Rosacea, skin trauma (like in the case of pulling associated with pore strips), sun exposure (another fabulous reason to wear sunscreen, guys).

As of right now, "there are no current guidelines to prevent telangiectases." So the best you can do is avoid/protect against behaviors that can cause them. Wearing sunscreen, avoiding pore strips, excessive facial massage when oil cleansing, wearing vaseline (or other protective products) when out skiing, drinking in moderation, not smoking, and exercising frequently are all behaviors you can engage in to reduce your risk of developing telangiectases.

The usual course of telangiectases is progressive, with spontaneous regression not occurring. Basically this means that they're permanent/get worse over time and don't heal on their own. Treatment will typically consist of laser ablation, sclerotherapy, or surgery. When beginning treatment, "capillary telangiectases (red telangiectases, usually <0.2 mm in diameter) should be distinguished from venous telangiectases (blue telangiectases, usually >0.2 mm in diameter). While venous telangiectases are quite responsive to sclerotherapy, capillary telangiectases are usually resistant to sclerotherapy. In fact, attempting sclerotherapy to remove capillary telangiectases carries a high risk of local development of new capillary telangiectases."

Here you can read a case study about the treatment of generalized essential telangiectasia via flashlamp-pumped pulsed dye laser. Below is a photo demonstrating the efficacy of test-doses with said laser treatment.

Another before and after laser treatment example- this time done on the face with a IDAS Laser

As of right now there are no topical products that can reduce the appearance of telangiectases. In some cases, oral medication can reduce the appearance of telangiectases, however, in most cases oral medication is not sufficient treatment.

As with every science post- I am not a doctor (I just play one on the internet). If you find anything here to be incorrect, please leave a comment in the doobly doo with your correction and a link to your source. Thanks for stickin' around to the end. You get a cookie.

Until next time, hoojoo fans.


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