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    Differentiating and treating vascular lesions in kids


    Classification tool resource

    A useful tool for assessing vascular lesions in children is available from the International Society for the Study of Vascular Anomalies (ISSVA). By entering “ISSVA Classification” into an Internet search, clinicians easily find this interactive site that provides a broad overview along with definitions and information on genetic mutations and associated syndromes.

    “This is an incredible classification system that will help dermatologists in evaluating a baby with vascular lesions and determining what they are dealing with,” Dr. Friedlander said.
    In terms of associations, new evidence suggests that in the case of a port wine stain, it is forehead involvement rather than distribution over the V1 area that presents a major risk factor for Sturge-Weber syndrome, she added.  

    “For the time being, however, I worry about kids who have a port wine stain with V1 or large, extensive involvement, as well as those whose lesion is on the forehead area. It is important to think about risk if the forehead is involved, even if it is not in the V1 distribution area,” Dr. Friedlander said.

    PDL for port wine stains

    Treatment with pulsed dye laser (PDL) continues to be a mainstay for treating port wine stains, and studies indicate that starting treatment early in life may afford the best outcomes. However, recent data suggesting that there is an increased risk of neurodevelopmental damage in children who are put under general anesthesia during the first two to three years of life is complicating the decision about when to begin PDL therapy.

    READ: 3-D imaging tracks port wine stain changes

    “Now we face a real conundrum about whether to try to provide the best results for the patient or if we should worry more about a theoretical neurological risk from early intervention,” Dr. Friedlander said.

    Based on the available evidence, she noted that when reasonable, she will try to delay treatment until the child is older or preferably use local anesthesia rather than general. 

    “The OR nurses, however, don’t like me so much when they have to deal with an awake and crying child,” Dr. Friedlander commented.

    NEXT: Caution around PDL


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