Heloma Vasculare/Heloma neurovasculare:
Vascular/neurovascular ‘corns’.
Disruptions of dermal/epidermal border from lesion allows small vascular and nerve elements to enter epidermis.
May follow repeated injudicious treatment by patient or health professional. Chilblains coexisting with a heloma may also disrupt the dermal/epidermal border.
Clinical features:
Similar to heloma durum – but after removal of overlying hyperkeratosis, the capillaries or nerves are seen within nucleus as red, yellow or silver thread like structures.
Usually very painful and sensitive on debridement
Treatment:
Debridement is more difficult – may need several visits; may need local anaesthetic; silver nitrate (escharotic) may help; analgesic properties of pyrogallol may help subsequent debridement; surgical removal by elliptical excision leaving linear scar (has risk of scar being painful as on weight bearing area).
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