Heloma Vasculare/Heloma neurovasculare:
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.
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
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).