Vascular disorders of skin

Benign Vascular Tumors - Friendly Neighborhood Vessels

• Cherry Hemangioma: Most common benign vascular tumor. Small, bright red papules appearing in adults; number increases with age. Do not regress.
• Spider Angioma: Central red arteriole with radiating capillaries that blanch with pressure. Associated with ↑ estrogen states (e.g., cirrhosis, pregnancy).
• Pyogenic Granuloma: Friable, red, polypoid papule. Grows rapidly and bleeds easily. Frequently follows trauma and occurs during pregnancy.
• Glomus Tumor: Painful, blue-red nodule, classically found under the nail. Arises from the thermoregulatory glomus body.

⭐ The classic triad for a Glomus Tumor is: intense paroxysmal pain, temperature sensitivity (especially to cold), and localized point tenderness.

Malignant Vascular Tumors - When Vessels Go Rogue

• Angiosarcoma

  • Rare, aggressive tumor of endothelial cells.
  • Associations: Chronic lymphedema (e.g., Stewart-Treves syndrome post-mastectomy), radiation therapy, sun exposure in the elderly (head/neck).
  • Presentation: Bruise-like patches or nodules that can ulcerate.
  • Histology: Interconnecting, anastomosing vascular channels lined by atypical, pleomorphic endothelial cells.

• Kaposi Sarcoma (KS)

  • Caused by Human Herpesvirus 8 (HHV-8).
  • Presentation: Red-purple macules, papules, or nodules on skin and mucosa.
  • Types: Classic (elderly Mediterranean men), Endemic (African), Iatrogenic (immunosuppression), AIDS-related.

⭐ High-Yield: Kaposi Sarcoma is an AIDS-defining illness, strongly associated with HHV-8 infection, particularly when CD4+ counts drop below 200/mm³.

Reactive Vascular Lesions - Skin's Red Alerts

• Pyogenic Granuloma (Lobular Capillary Hemangioma)

  • Rapidly growing, friable, red papule often at sites of minor trauma.
  • Common on gingiva (pregnancy tumor), fingers, and lips.
  • Misnomer: neither infectious nor a true granuloma.

• Bacillary Angiomatosis

  • Caused by Bartonella spp. in immunocompromised hosts (e.g., HIV with CD4 <100).
  • Red/purple papules/nodules resembling Kaposi sarcoma.
  • Histology: Capillary proliferation with neutrophils and nuclear dust.

• Cherry Angioma

  • Most common benign vascular tumor; small, bright red papules.
  • Increase in number with age; do not spontaneously regress.

⭐ Bacillary angiomatosis is caused by Bartonella henselae or B. quintana and requires antibiotics, distinguishing it from the viral etiology of its mimic, Kaposi sarcoma.

• Cherry hemangiomas are the most common benign vascular tumors in adults, often appearing in middle age.
• Strawberry (juvenile) hemangiomas are common in newborns, grow rapidly, and typically regress spontaneously.
• Pyogenic granulomas are rapidly growing, friable red papules often seen in pregnancy or after trauma.
• Bacillary angiomatosis, caused by Bartonella spp. in the immunocompromised, mimics Kaposi sarcoma.
• Kaposi sarcoma is an HHV-8 associated malignancy, presenting as purple lesions in AIDS patients.
• Angiosarcoma is a rare, aggressive malignancy of the head and neck in the elderly.