Pregnancy introduces various temporary changes to the body, including alterations to the skin like melasma and stretch marks. Among these dermatological shifts are vascular lesions, which occur due to changes in the circulatory system. Angiokeratomas represent one such vascular manifestation that can appear during gestation. This article addresses whether these small blood vessel growths ultimately disappear after delivery.
Angiokeratomas: Appearance and Location
Angiokeratomas present as small, raised bumps, typically measuring one to five millimeters across. They are characterized by a dark coloration—deep red, purple, or black—and can be mistaken for other skin conditions. The surface is often rough, firm, or wart-like, a result of the thickening of the overlying skin layer, known as hyperkeratosis.
The lesions are collections of dilated capillaries near the skin’s surface, occurring singly or in clusters. In the context of pregnancy, they often appear in areas subject to increased venous pressure, particularly the vulva, where they are classified as Angiokeratoma of Fordyce. They may also be observed on the lower extremities. Because they are vascular, these lesions are prone to bleeding if scratched or irritated.
The Connection Between Angiokeratomas and Pregnancy
The development of angiokeratomas during pregnancy is linked to profound physiological changes. A significant factor is the dramatic increase in total blood volume, which can rise by up to 50% during gestation. This increased volume places greater strain on the vascular system, leading to the dilation of capillaries close to the skin’s surface.
The mechanical pressure exerted by the growing uterus also contributes to lesion formation. The uterus compresses major veins returning blood from the lower body, causing venous stasis and a substantial rise in hydrostatic pressure in the pelvis and lower limbs. This pressure physically distends the capillaries in vulnerable areas like the vulva and lower legs, leading to the formation of the angiokeratoma papule. High circulating levels of hormones like estrogen and progesterone may also influence vascular walls, making the capillaries more susceptible to dilation.
Prognosis: Do Pregnancy-Related Angiokeratomas Resolve?
Whether pregnancy-related angiokeratomas resolve after delivery depends on the underlying mechanism of their formation. Many vascular changes that occur during pregnancy, such as spider veins (telangiectasias), tend to regress naturally as blood volume and hormonal levels return to the pre-pregnancy state. This normalization typically takes place within a few months postpartum.
However, true angiokeratomas are characterized by permanent dilation and thickening of the capillary walls in the superficial dermis, making them less likely to disappear completely. While the lesions may shrink as venous pressure decreases post-delivery, the structural changes and overlying skin hyperkeratosis often persist. Once a true angiokeratoma has formed, it often remains present, unlike more superficial vascular dilations.
Healthcare providers recommend a period of watchful waiting, typically three to six months following delivery, before considering intervention. This observation window allows the circulatory system to stabilize and confirms whether the lesions are temporary vascular changes or persistent angiokeratomas. Persistence or a slight reduction in size is the more common outcome, though complete spontaneous resolution has been documented in rare cases.
Treatment Options for Persistent Lesions
For lesions that do not resolve and cause discomfort, bleeding, or cosmetic concern after the observation period, several minimally invasive treatment options are available. Treatment is typically elective, as the lesions are benign. The goal is the destruction or removal of the dilated blood vessels and the thickened overlying skin.
Cryotherapy and Electrocautery
One common method is cryotherapy, which involves freezing the lesion with liquid nitrogen to destroy the vascular tissue. Another option is electrocautery, which uses a high-frequency electrical current to heat and coagulate the blood vessels and tissue. Both procedures are usually performed in an outpatient setting with local anesthesia.
Laser Treatments
Laser treatments are highly effective for persistent angiokeratomas. The pulsed dye laser (PDL) is often used because its wavelength targets the hemoglobin in the blood vessels, causing them to collapse and be absorbed by the body. Other lasers, such as the 532-nm potassium-titanyl-phosphate (KTP) laser, also achieve good results with minimal scarring.