Telangiectatic Warts

Telangiectatic warts, also known as angiokeratomas, are benign skin growths that are typically found on the lower extremities, but can also appear on the trunk, hands, and genitals. These warts are characterized by a red or purple coloration and a cluster of small, dilated blood vessels. They can be categorized into several different types based on their location, appearance, and underlying causes.

In this article, we will explore the different types of telangiectatic warts, their causes, symptoms, and treatment options.

1. Classic Telangiectatic Warts

The classic type of telangiectatic warts typically appear as small, dark red or purple bumps with a slightly raised surface. They are usually less than 1cm in diameter, but can grow larger over time. These warts are commonly found on the legs and feet, but can also occur on the hands, trunk, and genitals.

2. Fordyce Spots

Fordyce spots are a type of telangiectatic wart that appear on the genitals. They are small, pale red or white bumps that usually appear in clusters. They are typically painless and do not cause any symptoms, but can be a source of cosmetic concern for some people.

3. Angiokeratoma of Mibelli

Angiokeratoma of Mibelli is a type of telangiectatic wart that appears as multiple, small, dark red or purple spots on the hands and feet. These warts are typically less than 5mm in diameter and have a slightly raised surface. They are more common in children and young adults.

4. Angiokeratoma of Fordyce

Angiokeratoma of Fordyce is a type of telangiectatic wart that appears on the scrotum or vulva. These warts are typically small, red or purple bumps that have a rough, scaly surface. They are usually painless and do not cause any symptoms, but can be a source of cosmetic concern.

5. Solitary Angiokeratoma

Solitary Angiokeratoma is a type of telangiectatic wart that appears as a single, dark red or purple bump on the skin. These warts are typically less than 1cm in diameter and have a slightly raised surface. They can occur anywhere on the body, but are most commonly found on the legs.

Causes

Causes for telangiectatic warts and explain each in detail.

1. Human papillomavirus (HPV): The most common cause of telangiectatic warts is infection with HPV. There are many different strains of HPV, but only a few of them cause warts.
2. Genetic predisposition: Some people are more susceptible to HPV infections than others due to genetic factors.
3. Weak immune system: People with weakened immune systems, such as those with HIV/AIDS or who have had an organ transplant, are more prone to developing telangiectatic warts.
4. Contact with infected surfaces: HPV can be spread through contact with infected surfaces, such as towels or gym equipment.
5. Direct contact with an infected person: HPV can also be spread through direct contact with an infected person, such as during sexual activity.
6. Poor personal hygiene: People who do not practice good personal hygiene may be more likely to develop telangiectatic warts.
7. Prolonged exposure to moisture: Prolonged exposure to moisture, such as in swimming pools or communal showers, can increase the risk of developing telangiectatic warts.
8. Wearing tight clothing: Wearing tight clothing can create friction and cause small breaks in the skin, making it easier for HPV to enter the body.
9. Shaving: Shaving can cause small cuts in the skin, which can make it easier for HPV to infect the body.
10. Scratching: Scratching or picking at warts can spread the virus to other parts of the body.
11. Nail biting: Nail biting can create small breaks in the skin around the nails, making it easier for HPV to enter the body.
12. Sharing personal items: Sharing personal items such as razors, towels, or nail clippers can spread HPV from one person to another.
13. Stress: Stress can weaken the immune system, making it easier for HPV to infect the body.
14. Age: Telangiectatic warts are more common in children and young adults.
15. Pregnancy: Hormonal changes during pregnancy can increase the risk of developing telangiectatic warts.
16. Sun exposure: Overexposure to the sun can weaken the skin and increase the risk of developing telangiectatic warts.
17. Smoking: Smoking can weaken the immune system, making it easier for HPV to infect the body.
18. Certain medications: Some medications, such as immunosuppressants, can weaken the immune system and increase the risk of developing telangiectatic warts.
19. Diabetes: People with diabetes are more prone to developing telangiectatic warts due to weakened immune systems and poor circulation.
20. Malnutrition: Poor nutrition can weaken the immune system and make it more difficult for the body to fight off HPV infections.

Symptoms

Symptoms of telangiectatic warts, along with some explanations and tips for management.

1. Red, purple or dark spots on the skin: Telangiectatic warts usually present as small, flat or raised bumps on the skin that are red, purple or dark in color. These spots are caused by the dilation of small blood vessels in the skin.
2. Itching: Itching is a common symptom of telangiectatic warts. The thickened epidermis of the wart can irritate the skin and cause itching.
3. Pain: Telangiectatic warts can be painful, especially if they are located on the soles of the feet or on the genital area. The pain can be caused by pressure or friction on the wart.
4. Bleeding: Telangiectatic warts can bleed if they are scratched or irritated. The dilated blood vessels in the wart can make it more prone to bleeding.
5. Crusting: Telangiectatic warts can become dry and crusty, especially if they are scratched or irritated.
6. Scaly skin: The thickened epidermis of the wart can cause the skin to become scaly and rough.
7. Burning sensation: Some people with telangiectatic warts may experience a burning sensation in the affected area.
8. Tingling sensation: Tingling or pins-and-needles sensation is another possible symptom of telangiectatic warts.
9. Swelling: Telangiectatic warts can cause swelling in the affected area, especially if they are located on the feet or legs.
10. Discomfort: Telangiectatic warts can cause a general feeling of discomfort, especially if they are located in areas that are frequently irritated, such as the genital area.
11. Ulceration: In rare cases, telangiectatic warts can become ulcerated, meaning that the skin over the wart breaks down and forms an open sore.
12. Thickening of the skin: The thickened epidermis of the wart can cause the skin to become thickened and calloused.
13. Changes in texture: Telangiectatic warts can cause the skin to become rough and bumpy.
14. Foul odor: In some cases, telangiectatic warts can emit a foul odor, especially if they become infected.
15. Spread to other areas: Telangiectatic warts can spread to other areas of the body, either by direct contact or through the bloodstream.
16. The appearance of multiple warts: Telangiectatic warts can appear in clusters, with multiple warts present in the same area.
17. Embarrassment: Telangiectatic warts located in the genital area can be embarrassing and may cause psychological distress.
18. Difficulty with daily activities: Telangiectatic warts on the feet or legs can make it difficult to walk or engage in other physical activities.
19. Difficulty with sexual activity: Telangiectatic warts located in the genital area can make sexual activity painful or uncomfortable.
20. Anxiety and depression: The physical symptoms and psychological distress associated with telangiectatic warts can cause anxiety and depression in some people.

Diagnosis

Common diagnosis and tests for telangiectatic warts:

1. Physical Examination: A visual examination of the wart and surrounding area is the first step in diagnosing telangiectatic warts.
2. Medical History: A detailed medical history is important in determining the type of wart and potential causes.
3. Biopsy: A small tissue sample may be taken and examined under a microscope to determine the type of wart and rule out other skin conditions.
4. PCR Test: Polymerase chain reaction (PCR) tests can detect the presence of HPV DNA in skin samples.
5. Skin Scraping: A scraping of the top layer of skin may be taken to examine the wart under a microscope.
6. Dermatoscopy: A special magnifying device is used to examine the wart for characteristic features.
7. Blood Tests: Blood tests can detect the presence of HPV antibodies, but are not routinely used in the diagnosis of telangiectatic warts.
8. Skin Culture: A sample of the wart may be taken and grown in a laboratory to identify the type of virus causing the wart.
9. Tzanck Smear: A sample of fluid from the wart may be taken and examined under a microscope for the presence of HPV.
10. Skin Biopsy: A small sample of skin tissue may be removed and examined under a microscope to confirm the diagnosis.
11. Imaging Tests: Imaging tests such as X-rays, CT scans, or MRI scans may be used to detect any underlying bone or tissue abnormalities.
12. Skin Surface Microscopy: A non-invasive imaging technique used to observe the surface of the skin to detect any changes or abnormalities.
13. Immunofluorescence: A type of microscopy that uses antibodies to detect the presence of HPV in skin samples.
14. Electrosurgery: A surgical procedure that uses electrical current to remove the wart.
15. Cryotherapy: A procedure that uses freezing temperatures to destroy the wart.
16. Laser Surgery: A surgical procedure that uses a laser to remove the wart.
17. Topical Medications: Topical medications such as salicylic acid, imiquimod, and retinoids can be applied directly to the wart to destroy the virus.
18. Immunotherapy: A type of treatment that stimulates the immune system to fight off the HPV virus.
19. Surgery: Surgical removal of the wart may be necessary if other treatments are unsuccessful.
20. Watchful Waiting: In some cases, telangiectatic warts may go away on their own without any treatment.

Treatment

Fortunately, there are various treatments available to manage this condition. Here are options to consider:

1. Topical keratolytics: These are agents that break down the keratin protein in the skin and help to exfoliate the affected area. Examples include salicylic acid, urea, and lactic acid. Topical keratolytics are available over-the-counter or by prescription, depending on their strength.
2. Cryotherapy: This involves freezing the affected area with liquid nitrogen, which causes the warts to peel off over time. Cryotherapy is a common and effective treatment for many types of warts, including telangiectatic warts.
3. Electrocautery: This is a procedure that uses heat to destroy the wart tissue. A special device delivers an electric current to the wart, which causes it to burn and eventually fall off.
4. Laser therapy: This involves using a high-energy laser to destroy the wart tissue. Laser therapy is a precise and effective treatment for telangiectatic warts, but it can be expensive and may require multiple sessions.
5. Excision: This is a surgical procedure that involves cutting out the wart tissue with a scalpel or other surgical tool. Excision is usually reserved for large or stubborn warts that have not responded to other treatments.
6. Imiquimod cream: This is a topical medication that boosts the immune system’s response to the wart virus. Imiquimod cream is usually applied to the affected area several times a week for several weeks.
7. Cantharidin: This is a chemical that causes the skin to blister and peel, which can help to remove the wart tissue. Cantharidin is applied directly to the wart and left in place for several hours before being washed off.
8. Photodynamic therapy: This involves using a special light and a photosensitizing agent to destroy the wart tissue. Photodynamic therapy is a relatively new treatment for telangiectatic warts, but it has shown promising results.
9. Duct tape occlusion: This involves covering the wart with duct tape and leaving it in place for several days. The theory behind this treatment is that the tape irritates the skin and stimulates the immune system to attack the wart virus.
10. Tea tree oil: This is a natural oil that has antiviral and antifungal properties. Tea tree oil is often used as a home remedy for warts, although its effectiveness for telangiectatic warts has not been well-studied.
11. Zinc oxide: This is a mineral that has astringent and antiseptic properties. Zinc oxide cream or ointment can help to dry out and heal the skin around the wart.
12. Garlic: This is a natural antimicrobial and antiviral agent. Crushed garlic can be applied directly to the wart and covered with a bandage. However, garlic can also irritate the skin and cause blistering or burning.
13. Aloe vera: This is a natural anti-inflammatory and moisturizing agent. Aloe vera gel can help to soothe and heal the skin around the wart.
14. Vitamin A: This is a nutrient that plays a role in skin health and immune function. Vitamin A supplements or topical creams may help to boost the immune system’s response to the wart virus.

References