Treatment of Red Spots

Dermatologists have the expertise to differentiate these many conditions that may all look like just a red spot. If the diagnosis is not obvious, dermatologists can judge if a punch biopsy will do, or if an excisional biopsy is better from the outset. After diagnosis, selection of the right laser is necessary, and the laser dermatologist is likely to have the different systems required. It is tempting to use Intense Pulse Light (IPL) devices but they are not selective or powerful enough.
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Lesions that respond to lasers used for other vascular lesions:

  • Spider nevi, cherry angiomas, capillary hemangiomas
  • Angiokeratomas

Lesions that do not respond to selective vascular lasers but treatable with Erbium or CO2 lasers:

  • Pyogenic granulomas, pink Intradermal nevus
  • Hemosideric dermatofibromas, angiofibromas, some neurofibromas
  • Lesions that respond to deep penetrating 1064 nm lasers that also treat venous malformations:
  • Bluish-red venous lakes
  • Lesions that will not respond to most lasers:
  • Tufted angiomas that resemble a small PWS
  • Experts may try fractionated CO2 or topical rapamycin.

Benign Lesions (a biopsy often necessary)

  • Clear cell acanthoma
  • A Spitz Nevus
  • Glomus tumor

Malignant (diagnosed by biopsy)

  • Amelanotic melanoma
  • Squamous cell carcinoma, basal cell carcinoma or Bowen’s disease, keratoacanthoma
  • Kaposi’s sarcoma, angio- and dermatosarcomas
  • Malignant vascular tumours

Selective Vascular Lasers

Selective vascular lasers were based on a principle that precise injury of a vessel was achieved by an optimal combination of light energy, delivered in short pulses, usually 1-40 milliseconds, depending on the size. The smaller the vessel, the shorter the pulse. This confined intense heat to the vessel and spared the adjacent tissues with a very low risk of scarring. These yellow light pulsed dye lasers (PDL) were the turning point in the evolution of modern cutaneous laser surgery.

Acne and acneiform papules that come with all forms of acne, including acne rosacea. These require specific medical treatment that usually do not involve lasers. There are blue light lasers and other light based treatments that may be used in certain cases of acne.

Some infections of the skin and hair follicles present as a boil or furuncle that will look like a red spot. Treatment measures include cleansers and topical or oral antibiotics.

Inflammatory red-brown lesions that present as a sclerotic or granulomatous nodules may be treated with CO2 or Nd:YAG lasers after the correct diagnosis ensures that laser ablation is appropriate.

Your dermatologist understands that many red-blue lesions may be a sign of systemic disease. They will remember the lymphocytic infiltrates, leukemic infiltrates, lymphomas and pseudo-lymphomas, and lupus.

Patient Example

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The first young patient is shown in the left photograph with a red nodule on the left cheek. The second case is a young infant shown in the bottom right photograph with another red nodule on the left cheek. To any observer they seem very similar in appearance. Both appear friable and look as if they may bleed easily. A dermatologist has the training and expertise to recognize the important difference:

The first patient has a infantile hemangioma that typically appears within the first few weeks of life. They may grow rapidly and enlarge, although most remain less than 2-3 inches in diameter.

The second patient (right) is a toddler with pyogenic granuloma that appeared a few weeks previously.

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