Dermatografie

Huidverkleuringen
Algemeen

Blue naevus: port-wine stains in coloured skin

Blue naevus and Mongolian spot, Naevus of Ito, Naevus of Ota (port-wine stains showing dark blue to black discolorations in patients of Asian origin) qualify for treatment with dermatography as well. Sometimes the discoloration is seen to extend into the white of the eye (the conjunctiva). This does not in itself constitute an impediment to the sight in the afflicted eye.

If such a discoloration is occurring in the cornea of these patients it may be corrected and provided with the correct colour using keratography.

See also: Indications for keratography

Laser treatment is not advisable for this category of patients, as the melanin (colouring the patient’s skin) may be influenced by the heat of the laser. This may lead to the port-wine stain turning black or showing serious discolorations in comparison to the surrounding skin which are difficult to improve. Treatment of patients of Melanesian, African or South-American origin is difficult in The Netherlands: the outward appearance of the afflicted skin may be the same as in patients of Caucasian origin, but a different type of diagnostic is required.

Some of the occurring forms of port-wine stains

After 27 dermatography treatments. Untreated blue naevus: see the magnification above


Klippel-Trenaunay syndrome

Just like the Sturge-Weber syndrome, the Klippel-Trenaunay syndrome is a rare congenital condition. The patient often displays a combination of one or more port-wine stains in the neck – usually outside the facial area, sometimes spreading to the full length of the arm, including the hand – and flebectasies or varicose veins. In some cases bone and soft tissues are hypertrophied.

Port-wine stains in Klippel-Trenaunay patients may be treated with dermatography, but treatment may constitute a considerable psychosocial burden for the patient, as it may stretch over a number of years before an acceptable final result is achieved.

A combined therapy of laser treatment and dermatography afterwards may be an option. The reversed order is not advisable: dermatography first and laser treatments afterwards may result in changes of the colour pigments caused by the heat of the laser.

This therapy can only be offered to patients above the age of 14.

Klippel-Trenaunay untreated

More information

Medical links:
http://www.sktn.nl

This type of dermatography requires a long term commitment of both the treating specialist and the patient. In the initial consult it will be stressed that treatment may take a number of years. It has been noted that diagnosing this type of patients is difficult, which in itself may be a cause of psychosocial stress for the patient.

You are always welcome for a second opinion in our clinic .(only on appointment).

Klippel-Trenaunay untreated

after 14 dermatography treatments

Spontaneous discoloration of the arm, possibly a result of dermatography treatment of the hand


Sturge-Weber syndrome

In most cases a port-wine stain is nothing but a bothersome skin imperfection. The stain may be coloured red to purple, sometimes with a slight elevation of the skin surface. In some cases however there are more serious complications. Especially when the port-wine stain is located in the upper half of the face the proliferation of blood vessels, which is the cause of the skin discoloration, may extend to the outer layers of the brain. Symptoms such as calcium depositions in the brain, epilepsy and glaucoma (increased eyeball pressure) are seen. This is known as the Sturge-Weber syndrome, in The Netherlands occurring in 1 in 250,000 births. Congenital port-wine stains on other parts of the body may indicate a different type of syndrome.

Existing medical therapies:

Surgical removal and subsequent application of skin grafts (plastic surgery); different types of irradiation.

Nowadays the majority of therapies consist of some type of laser treatment. The results often are not or only partly successful. For port-wine stains in patients with the Sturge-Weber syndrome, dermatography or a combined therapy of laser treatment and dermatography afterwards may be an option. The reversed order is not advisable: dermatography first and laser treatments afterwards may result in changes of the colour pigments caused by the heat of the laser. A positive aspect of dermatography is that simultaneously intracicatricial keloidectomy can be applied to make the existing scar tissue suppler and smoother.

This therapy can only be offered to patients above the age of 14.

You are always welcome for a second opinion in our clinic .(only on appointment).


More information

Medical links:
http://www.nswv.nl
http://www.glaucoomvereniging.nl
http://www.epilepsie.nl

Before: Sturge-Weber syndrome after plastic surgery
After: 16 dermatography treatments

Before: Sturge-Weber syndrome after plastic surgery, irradiation and skin grafts
After: 21x dermatography

Before: Sturge-Weber syndrome after years of plastic surgery, including skin grafts
After: 36x dermatography, scar tissue reduced and made supple and smooth by intracicatricial keloidectomy

Scars after trauma and surgery

In persons with white or coloured skin. See also: Scars, burns and post-laser file.

Before: discolorations and scars after face-lift
After: 7x dermatography

Before: discolorations and scars after surgical intervention
After: 14x dermatography



X-ray-therapy or radiotherapy

This type of therapy often takes place after tumour surgery, sometimes in combination with chemotherapy. It may cause conspicuous discolorations of the skin (telangiectasia), which look like port-wine stains or “couperose”(rosacea).

Before: teleangiectasy after tumour excision in the neck with radiotherapy
After: 14x dermatography

Birthmarks, café-au-lait stains, liver spots (lentigo), freckles

Hyperpigmentation can be treated with dermatography if benign.

Existing medical therapies for these types of discoloration are::

● Bleaching with phenolic compounds: Hydrochinone, 4- methoxyphenole 20% with or without added corticosteroids).
● Bleaching with non-phenolic compounds: tretinoin, azaleinic acid 20%, N-acetylcystein with or without added corticosteroids.
● Combination therapies and chemical peelings, including glycolic acid 30-70%, trichloroacetate 10-70%, resorcinol 20-50% and combinations of these with bleaches.
● Laser therapies: Q-switched ruby laser, pulse-dye laser, alexandrite laser, Nd:YAG laser, argon laser and CO2

Unsuccessful treatment ...

A patient with an extensive café-au-lait stain (actual indication: naevus of Becker) on the shoulder and upper arm was treated in a burns centre by a plastic surgeon who apparently lacked experience with the use of laser. After this therapy failed a split-skin graft was applied. The final result was poor, whereas dermatography is usually indicated for this type of stains with no negative effects. In this particular case however, the large size of the afflicted area of skin was a contra-indication for dermatography.

Combinations of drugs and hormone preparations

Before: discoloration after drug use (hydrochinone and loco-corticosteroid
After: 4x dermatography, result very acceptable to patientt

Before: discoloration after drug use (hydrochinone and depigman)
After: 43x dermatography: increased melanin production may necessitate very lengthy treatment to obtain a good result.