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Owrzodzenia najczęstszym powikłaniem naczyniaków krwionośnych u dzieci

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Naczyniaki krwionośne to łagodne nowotwory naczyń, które mogą być obecne już przy narodzinach dziecka. Wystąpienie naczyniaka może się wiązać z poważnymi powikłaniami, wśród których najczęstsze są owrzodzenia.

Naczyniaki krwionośne występują u 1,1-2,6 proc. noworodków i 10-20 proc. dzieci przed ukończeniem 1. roku życia. Częściej obserwuje się je u wcześniaków. W pierwszym roku życia dziecka występuje gwałtowny wzrost zmian chorobowych (faza proliferacyjna), po którym następuje stopniowa regresja trwająca do 7.-10. roku życia dziecka (faza inwolucji).

Fazy rozwoju naczyniaka krwionośnego

W fazie proliferacji, która rozpoczyna się ok. 3.-6. miesiąca życia, naczyniak osiąga maksymalne rozmiary. Wygląd zmian chorobowych zależy od ich położenia. Naczyniaki umiejscowione w powierzchownych warstwach skóry mają postać jasnoczerwonych guzków. Zmiany powierzchniowe dzieli się na ograniczone i segmentarne (ułożone wzdłużnie lub geograficznie). Zmiany położone głębiej uwidaczniają się jako miękkie masy o sinej lub niebieskawej barwie, które pokrywa prawidłowa skóra.

W fazie inwolucji naczyniaki zmieniają barwę z czerwonej na szarą i stają się bardziej miękkie w dotyku oraz mniej napięte. Inwolucja może się rozpocząć od środka zmiany chorobowej. U ok. 50 proc. pacjentów po ustąpieniu naczyniaka pozostają teleangiektazje, żółtawe przebarwienia, zmarszczki zanikowe oraz łysienie.

Naczyniaki a owrzodzenia

Najczęściej występujące powikłanie naczyniaków krwionośnych stanowią owrzodzenia. Szczególnie dużym ryzykiem wystąpienia owrzodzeń obarczone są zmiany występujące w obrębie głowy, szyi, krocza i warg.

Owrzodzenia mogą w ciężkich przypadkach prowadzić do uszkodzenia tkanek miękkich, bliznowacenia oraz upośledzenia czynności narządu objętego zmianami chorobowymi. Mogą się również wiązać ze znacznymi dolegliwościami bólowymi. W części przypadków obserwuje się dodatkowe powikłania w postaci krwawień i miejscowych zakażeń.

Leczenie owrzodzeń występujących w przebiegu naczyniaków krwionośnych obejmuje trzy części: terapię bólu, zahamowanie proliferacji naczyniaka oraz zmianę lokalnego środowiska.

W leczeniu stosuje się glikokortykosteroidy, propranolol (beta-bloker przyspieszający proces inwolucji zmiany), bacytracynę i mupirocynę. Miejscowa pielęgnacja rany powinna przebiegać według standardowych procedur stosowanych dla ran trudno gojących się. Jako leczenie wspomagające w części przypadków stosuje się laseroterapię z wykorzystaniem lasera PDL.

Źródło:

R.A. Schwartz, M.I. Sidor i in., „Naczyniaki krwionośne u dzieci: wyzwanie dermatologii pediatrycznej”, „Dermatologia po Dyplomie” 2010, 1(5): 67-76/

Przeczytaj także: Badanie: immunoterapia w onkologii a zmiany skórne

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