Chapter: Consultation hour
Article: 5 of 12
Update: Feb 24, 2021
Author(s): Wohlgemuth, Walter A.
The skin affected by a vascular anomaly is often particularly sensitive to injury, inflammation or wounds either directly (skin infiltration through the vascular defect) or indirectly (e.g., chronic inflammation, high tissue fluid pressure due to lymphedema or phlebedema or lymphorrhea). Furthermore there is the additional mechanical strain on the skin caused by compression garments.
It is therefore very important to protect the skin from injuries, which often heal less well.
Increased tissue fluid pressure, especially in the lower extremities of patients with venous and lymphatic malformations, results in additional skin stress. Patients with arteriovenous malformations of the lower extremity or pelvis also suffer from venous hypertension of the ipsilateral extremity caused by the high venous pressure in the area of the AV fistulas.
In an area of extensive capillary malformation, especially in connection with Klippel-Trénaunay syndrome, small pinhead-sized speckles, usually filled with bloody discolored lymph, can form on the skin (so-called petechiae). These are very sensitive to even mild mechanical stress and can begin to leak at the slightest touch and secrete clear or bloody-colored lymph. If overlying small crusts are removed, which are caused by dried up lymph, fresh lymph will leak out directly from these spots. Warm water (e.g., shower) also has a similar effect. In this case, an interventional closure by sclerotherapy of the affected lymph vessels may be indicated.
Suitable clothing and well-adapted compression garments offer some protection against mechanical skin irritation. Correct and optimal fit is the most important factor, especially of compression garments, as this can also be the source of additional skin damage. Thus, individually tailored and non-standard compression garments are mandatory for patients with vascular anomalies, especially as the extremities are often unusually shaped and outside the norm due to accompanying circumscribed soft tissue overgrowth.
It is particularly important that the compression garment fits perfectly in the hollow of the knee and on the back of the foot or in the instep. These areas are exposed to the highest mechanical stress. If the compression fabric does not fit perfectly here, there is significantly increased skin stress. Poorly fitting compression garments as well as compression garments with pressing, unfitting seams (flat knit fabrics) must be replaced.
Sewn-in or inserted pads to increase local compression can be very useful, but they must also be particularly well adapted, otherwise there is an even greater risk of skin injury.
Always apply a strong enough sun screen as an ointment, spray or lotion on affected skin before sun exposure. This is particularly important because of the frequent accompanying discolorations of the skin (e.g. reddish skin color in capillary malformation), which make it difficult to detect early the first signs of sunburn with slight skin redness.
The affected sensitive skin areas must be kept particularly clean. If the skin type is rather dry or moist for constitutional reasons or due to the vascular anomaly, regular skin care with appropriate preparations is recommended. Pay attention to the pH value of the preparation, as the physiologically somewhat acidic pH value of the skin is a prophylaxis against infections. Refatting, pH-neutral preparations without additives help to avoid local allergies and skin reactions in the long term.