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Suggest Treatment For Vascular Lesion

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Posted on Thu, 14 Apr 2016
Question: Please take a look at the attached photo....can't tell if I have a vascular lesion that can only be addressed with a laser treatment or electrocautery? Had a cortisone shot about 4 weeks ago and had been taking Elidel for 2 weeks but sopped because I felt it was triggering some excess hyperpigmentation. Not sure what to do now...whether this just needs time to resolve or if laser needed. I'm hesitant to pursue laser given the brownish hyperpigmentation I already notice on the edges of the blemish. Another doc recommended a topical steroid but not sure if that is safe since I had the direct steroid shot 4 weeks ago.
doctor
Answered by Dr. Asmeet Kaur Sawhney (50 minutes later)
Brief Answer:
No need of laser and electrocautery, can safely go for topical steroid

Detailed Answer:
Hi
Thanks for writing to us at healthcaremagic

I have reviewed the attached photograph.

Their is no need of laser treatment or electrocautery.

If you are hesitant in using elidel cream you can easily stop it.

According to me you should stop worrying about it as it will resolve with time on its own but if you want to hasten the resolution of the spot use topical steroid like mometasone cream on the affected area once daily for 2-3 weeks.

I know you are worried about the safety of steroid since you have already taken a steroid shot but topical steroid will be safe and the most effective way of treating it at the earliest.

Regards
Dr Asmeet

Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (3 hours later)
Thank you for the detailed reply. Couple follow-ups-

1) i have noticed periodic tingling in the blemish area where i got the steroid shot, even after 4 weeks since the time of the injection. Is that normal? It doesnt bother me but i wonder if that means the steroid injection is still actively working under the skin to reduce inflammation?

2) before i had the injection the doc had given me Cordran to apply topically. I did this for about a week but was not seeing a material change so i opted for the steroid shot. Do you think restarting the Cordran would now be effective as a topical steroid solution? What are the risks of using Cordran now? Is it likely to increase post-inflammatory hyperpigmentation? Or alternatively would the Cordran be effective to more rapidly decreasing the post-inflammatory hyperpigmentation?

3) the areas around the edge of the blemish are now more brown than pink- is this just the normal color transition of something like this? (i.e. Blemish evolves from dark red/purple to lighter red to pink to brown to normal color)? That has been the transition thus far. Whole thing started dark red/purple, then moved to a brighter red, and now after 2 weeks of Elidel the middle part remains pink while the outsides are more brownish. Does this indicate normal color progression as the skin heels?

4) in lieu of using the topical Cordran steroid what other OTC topicals would be effective? Im nervous to pursue any retinol products due to my sensitive skin and redness. However, what about vitamin C serums? Or what other non-hydroquinone natural fade creams? Or what other OTC products would work here? Or ultimately do you think these products would be a waste of time to just going back to a few more weeks of the steroid cream/Cordran?

Thank you.
doctor
Answered by Dr. Asmeet Kaur Sawhney (30 minutes later)
Brief Answer:
Explanation below

Detailed Answer:
Hi, welcome back,
It is normal to experience mild tingling after steroid injection.

The duration of action of the steroid will depend on the steroid injected, whether it was long acting or short acting.

Cordran cream will also take time to act. 1 week is too less a time to assess its efficacy. According to me you should opt for some mid potency steroid like mometasone because it has less side effect profile as compared to a high potency steroid.

Topical steroids will help in reducing the redness as well as post inflammatory hyperpigmentation.

Cordran cream can lead to thinning of skin, pimples, increased hair growth and dialated blood vessels if used for a long duration without supervision of a doctor.

Yes it is a normal response of the skin to turn from red to brown to normal as the inflammation settles.

I could appreciate only the red spot in the photograph you have uploaded. In case of redness topical steroids would be effective but if there is brownish pigmentation then you can opt for kojic acid cream or azelaic acid cream. Vitamin C serum won't be very effective.

Hope you found the answer helpful.

Let me know if I can assist you further.

regards

Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (38 minutes later)
So ultimately your preference to Cordran is mometasone? And is it safe to assume you prefer mometasone to Elidel as well? And on mometasone you estimate another 2-3 weeks would be necessary to materially clear up the blemish

You list above the primary risks to Cordran - what are the primary risks to Mometasone? Is there a risk the mometasone triggers additional post-inflammatory hyperpigmentation?

I may be overstating the brownish hyperpigmentation currently. It may just be he temporary evolution of the skin as it transitions from pink to brown to clear. I do notice the brownish part sometimes looks normal depending on the light, so perhaps this means it is nearing completion in the healing process versus being a more permanent pigmentation issue that will take longer to resolve??
doctor
Answered by Dr. Asmeet Kaur Sawhney (5 hours later)
Brief Answer:
Please follow the details below

Detailed Answer:
Yes I am preferring mometasone to Cordran.

Mometasone will be more effective than elidel in dealing with this condition.

Yes perhaps 2-3 weeks will be sufficient to clear the redness and brown discolouration. Mometasone is also a steroid which can lead to same side effects if used for a long time unsupervised but its safety profile is better than cordran and will not cause any problems on 2-3 weeks usage.

Mometasone won't trigger post inflammatory hyperpigmentation.

Yes brownish colour is a part of natural transition. I don't think you need to worry about it much. In most of the cases it resolves even without any active treatment.

Regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (13 hours later)
Based on our conversation, as well as the general color transition of skin blemish (purple-> dark red-> red-> pink -> brown -> normal) i am now thinking that my use of Elidel IS having the desired effect, just happening a bit more slowly than i originally expected. A prior doc i checked with seemed skeptical that Elidel would cause an adverse reaction and trigger further inflammation/hyperpigmentation. He noted it is very well tolerated even for very sensitive skin and does not carry the negative side effects of topical steroids.

Blemish is definitely slowly getting lighter and lighter, and the edges i perceived as post-inflammatory hyperpigmentation may just reflect the normal healing process (due to the original steroid injection and use of elidel for 2 weeks).

I had read online that elidel can clear up redness in a matter of days so i figured since all the redness is not yet gone after 2 weeks it must not be working at all. However, i think it is, just more slowly than i was expecting. Can you comment on how long one may need to apply Elidel before seeing material results? And do you agree it is safe for me to continue to use for a couple more weeks as the blemish continues to heal?

Given my original doc gave me the elidel, and a 2nd opinion doc also thought elidel was appropriate i think i will stay the course with this for now. The 2nd opinion doc felt the combo of the elidel plus "tincture of time" was best approach to let the skin heal on its own. His view was that the skin already went thru enough trauma (the original injury plus the initial topical Cordran plus the steroid injection) that it simply needed to be left alone and given time to heal naturally. Despite being a IPL laser expert he dismissed that option outright as too aggressive and unecessary. You seemed to agree with this view in your first post, that the mere passage of time will ultimately resolve this issue. He told me to come back and see him again if there hasnt been notable improvement after a month. Perhaps if i reach that point and blemish has not shown more improvement i will ask him about mometasone. However, i am nervous to move to the steroid now and introduce something more aggressive to the skin.

What do you think?
doctor
Answered by Dr. Asmeet Kaur Sawhney (9 minutes later)
Brief Answer:
You are right, continue with elidel

Detailed Answer:
I think you are absolutely right. You need to be patient and give the skin time to heal on its own.

However you can continue using elidel. It may take 4-6 weeks to start showing the desired results.

Wish you speedy recovery.

Regards
Dr Asmeet
Above answer was peer-reviewed by : Dr. Naveen Kumar
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Dr. Asmeet Kaur Sawhney

Dermatologist

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Suggest Treatment For Vascular Lesion

Brief Answer: No need of laser and electrocautery, can safely go for topical steroid Detailed Answer: Hi Thanks for writing to us at healthcaremagic I have reviewed the attached photograph. Their is no need of laser treatment or electrocautery. If you are hesitant in using elidel cream you can easily stop it. According to me you should stop worrying about it as it will resolve with time on its own but if you want to hasten the resolution of the spot use topical steroid like mometasone cream on the affected area once daily for 2-3 weeks. I know you are worried about the safety of steroid since you have already taken a steroid shot but topical steroid will be safe and the most effective way of treating it at the earliest. Regards Dr Asmeet