Vascular Lesions of Skin 85 



Osier's Disease 



{Hereditary Hcemorrhagic Telangiectasia) 



The cutaneous lesion in Osier's disease is usually flat, 

 punctiform, with sharp margins. Solid bluish lesions may 

 occur. The mucous surfaces of the body, especially of the 

 mouth and lips, are favourite sites. Bleeding is common as 

 would be expected from the vascular fault, a deficiency of 

 smooth muscle and elastic tissue in small veins, arteries 

 and capillaries. The trait is transmitted without sex 

 linkage as a Mendelian dominant. Recently a number of 

 persons with this disorder have been observed to develop 

 pulmonary arteriovenous aneurysms. Age: I have observed 

 some children with no skin lesions who bled from the nose 

 and after the age of puberty atypical telangiectases appeared 

 in the skin. Bleeding is rare before puberty. It most often 

 becomes a clinical problem during the third decade and so 

 remains throughout life. There may be slow increase in size 

 of some lesions, others may vanish but the change is usually 

 gradual over a period of years. 



Venous Lakes 



In recent years I have made observations on a dilated 

 venous structure found on the ears and lips of old persons. 

 They are rare in women, but not so rare in old men. In colour 

 they are dark blue. Pressure on them causes fading or com- 

 plete blanching. They refill slowly. Histological section 

 reveals a thin vascular structure with walls resembling veins. 



Discussion 



The life of man witnesses many changes in blood vessels — 

 the great proliferations during embryonic life, the sharp shifts 

 of the neonatal period, the tendency for birthmarks and 

 haemangiomas generally to disappear during the early years 

 of life. But there are vascular alterations of another class 

 readily observed in vessels of the skin, which increase in size, 



