Patient Presentation
A 7-year-old female came to clinic for a rash. She had dry, reddened skin on her forearms, wrists and knees for the past week. She had tried some lotion once without improvement. She had no new exposures to sunscreen, insect repellent, hygiene or laundry products, etc. Her mother also asked to have her “unicorn star” looked at as some of her classmates had been teasing her about it. The “star” was a small red spot in the center of her forehead. The mother said the lesion had been there for a long time and perhaps had gotten slightly bigger. The past medical history showed seasonal allergic rhinitis and atopic dermatitis.
The pertinent physical exam showed a healthy female with normal vital signs and growth parameters in the 10-50%. Her examination was non-contributory except for her skin examination. She had dry, slightly reddened skin along both forearms, wrists and the extensor surfaces of her fingers. She had similar findings on the extensor surfaces of her knees and upper calves. On her forehead she had a 2 mm slightly raised, papule that was bright red. Magnification using an otoscope shows some very small “spider-like” vessels radiating an additional ~2 mm from the lesion. There was no perceptible halo around the lesion. No other lesions were noted.
The diagnosis of atopic dermatitis and a small spider telangectasia were made. The pediatrician recommended standard atopic dermatitis treatment be restarted. “The unicorn star is something we call a telangectasia. They usually don’t cause any problems but for some people they are a cosmetic problem,” she said. “They can be treated by a dermatologist, usually with laser or some kind of light treatment. I don’t know all about it, but I can send you to the dermatologist to talk about it including the risks and benefits of the treatment,” she continued. The girl piped up, “But I like my star!” “I know you do and so do I, but I think I want to talk with the doctor about the choices we have now and maybe in the future,” her mother responded.
Discussion
Spider telangiectasia or spider angiomas have a central red lesion with radiating dilatation of the distal, end vasculature that resemble arachnid appendages. They are common lesions (up to 38% in one study of children, and 60% in pregnant women), often solitary or < 3 lesions, and usually benign. Multiple lesions are characteristic of chronic liver disease. They can disappear over time (especially pregnancy related ones) but may not. The cause of these vascular lesions is unknown. Treatment is often not necessary, but laser treatments, fine needle electrocautery or electrodissection can be used.
Learning Point
Although the principals of LASER (i.e. light amplification by the simulated emission of radiation) was discussed by Einstein in the 1920s, the 1950s and 1960s saw the birth of the fundamentals of the technology with Nobel and other prizes being given for this work. Gordon Gould coined the phrase “LASER.”
Medical uses of light treatment comes in many different forms including the phototherapy for newborn jaundice commonly used in pediatrics, or light boxes for seasonal affective disorder. They have many uses within the surgical theaters. See the PubMed search below for a breadth of these indications.
The field of lasers and other similar light technologies has rapidly expanded with new indications, technologies, and increased distribution of the light devices into medical and other health related locations (e.g. spas). Basic treatment for dermatological conditions includes a light source of various wavelengths that is applied for various amounts of time during an individual treatment, and multiple treatments may be necessary. Different light treatment devices are applied in a single discrete location, multiple discrete locations or in a larger area by application of a predetermined scanning pattern. The skin area may also be given pretreatments such as mild dermabrasion and or localized photosensitizing drugs to assist with the treatment efficacy. The light sources are not necessarily a laser device but can include light emitting diodes or intense pulsed light devices. The term laser is often used by laypersons and health care providers as a generic term for such light based dermatological treatments.
Possible problems include pain during treatment or afterwards, burn, scarring, pigmentary changes, hair changes, infection, etc. Problems are more common when used by persons with less training using the light treatment devices.
Light based treatment indications includes:
- Hemangiomas or other blood vessel lesions such as spider telangectasias
- Acne – effective for inflammatory acne not comedomal
- Verrucae
- Scar treatment
- Epilation
- Pigment removal – e.g. tatoos, unwanted melanin
- Photorejuvenation
- Actinic keratosis or chelitis
- Non-melanotic skin cancer
- Sebaceous hyperplasia
- Rosacea
Questions for Further Discussion
1. How do you use light therapy for seasonal affective disorder? A review can be found here
2. What are types of true laser devices used by dermatologists?
Related Cases
- Disease: Spider Telangectasia | Vascular Disease
- Symptom/Presentation: Vascular Lesions | Eczematous Dermatitis
- Specialty: Dermatology
- Age: School Ager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Vascular Diseases
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
Hersant B, SidAhmed-Mezi M, Bosc R, Meningaud JP. Current indications of low-level laser therapy in plastic surgery: A review. Photomed Laser Surg. 2015;33(5):283-297. doi:10.1089/pho.2014.3822
Paasch U, Schwandt A, Seeber N, Kautz G, Grunewald S, Haedersdal M. New lasers and light sources – Old and new risks? J Dtsch Dermatol Ges J Ger Soc Dermatol JDDG. 2017;15(5):487-496. doi:10.1111/ddg.13238
Benedetto AV. What’s New in Cosmetic Dermatology. Dermatol Clin. 2019;37(1):117-128. doi:10.1016/j.det.2018.08.002
Ozog DM, Rkein AM, Fabi SG, et al. Photodynamic Therapy: A Clinical Consensus Guide. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2016;42(7):804-827. doi:10.1097/DSS.0000000000000800
Kwon E-KM, Seefeldt M, Drolet BA. Infantile hemangiomas: An update. Am J Clin Dermatol. 2013;14(2):111-123. doi:10.1007/s40257-013-0008-x
Samant H, Kothadia JP. Spider Angioma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019. http://www.ncbi.nlm.nih.gov/books/NBK507818/. Accessed September 3, 2019.
Laser. In: Wikipedia. 2019. https://en.wikipedia.org/w/index.php?title=Laser&oldid=912216041. Accessed September 3, 2019.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa
Pediatric Education 