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Is the problem of skin diseases in children urgent? Causes of angioma of the skin

Dermatological pathology - skin angioma - is a localized vascular anomaly in the form of tumor-like growths of deformed capillaries or venules located in the dermis and subcutaneous tissue. These formations can be both protruding above the surface of the skin, and completely flat, often called birthmarks.

Angiomas are one of the most common skin defects. ICD code 10 - class XII (diseases of the skin and subcutaneous tissue), L98.

ICD-10 code

D18.0 Hemangioma, any site

Causes of angioma of the skin

Today in dermatology it is customary to distinguish the following forms of skin angioma:

  • red mole or angioma (cherry angioma, Campbell de Morgan spots);
  • wine birthmarks or port wine stains (or nevus flammeus, that is, a flaming nevus);
  • formations of blue and purple color or venous lakes;
  • spider angioma (spider nevus);
  • cavernous or cavernous (having a cavity) angiomas - vascular tumors in the subcutaneous tissue.

Pathogenesis is defined as a congenital defect in the vessels of the skin and subcutaneous tissue. This defect, according to statistics from foreign experts, is present in 0.7-1.8% of newborns and in 10-15% of premature babies and infants with initial low weight.

Some dermatologists associate the causes of angioma of the skin with degenerative changes in the collagen fibers surrounding these blood vessels, which deprive them of the necessary structural support and leads to dilatation (that is, expansion). Another point of view on the pathogenesis of angiomas: the proliferation of blood vessels in the skin is due to the proliferation of endothelial cells lining the inner walls of the vessels. The appearance of wine birthmarks - diffuse capillary skin lesions - is considered the result of a violation of the local innervation of the capillary network. However, all these pathological processes have genetic causes. Although angiomas of the skin in the form of small cherry or red moles (Campbell de Morgan spots) appear in people after 30-40 years (increasing in size and number), as well as after 60 (senile angioma or hemangioma).

Until now, there is no single classification of skin angiomas and there is an obvious terminological inconsistency, which introduces a lot of confusion in the description and diagnosis of these anomalies. Skin angiomas - as a type of congenital vascular pathologies, have a number of names: vascular malformations (defects) of the skin, capillary angiodysplasias, hemangiomas (which may not be congenital and occur at any age), vascular nevi (although nevi are associated with the production of skin pigment melanin ).

Specialists of the American National Skin Care Institute distinguish congenital vascular defects depending on the type of vessels involved: CM (capillary malformation), VM (venous), CVM (capillary-venous), CLM (capillary-lymphatic), LVM (lymphatic-venous), CLVM (capillary-venous-lymphatic malformation), etc.

Complications of skin angiomas can occur with traumatic exposure to them, which is fraught with bleeding. Also, the possibility of the formation of capillary microthrombi and the development of inflammation in the form of a purulent granuloma is not excluded. In addition, it should be noted that the so-called spots of port wine of an especially large size, located on the face, can be with vascular tumors of the pia mater of the brain and indicate a severe congenital pathology of Sturge-Weber-Crabbe syndrome (total damage to the central nervous system with impaired physical and mental development ).

Cutaneous angiomas do not threaten cancer, and their prognosis is favorable in the vast majority of patients. However, in very rare cases, angiosarcoma of the skin or malignant hemangioendothelioma is possible.

Symptoms of skin angioma

The first signs of the presence of an angioma on the skin of various parts of the body in the form of a nodule of a cherry or red mole are detected visually at the birth of a child or in an adult. They can be flat or hemispherical, do not disappear when pressed, do not cause disturbance, and do not cause any sensations.

The wine birthmark (a type of capillary malformation) is also easy to recognize: a newborn already has it; never rises above the skin; has all shades of red and pink, a variety of sizes and outlines (with fuzzy borders); localized on the face or head. These spots can also grow as children grow and take on a rich purple color. They account for over 10% of vascular malformations.

Diffuse capillary angiomas of the skin, salmon-colored (yellow-pink) and called "stork mark", are found in infants on the scalp, neck, forehead or eyelids. Over time, they regress and disappear by themselves.

Symptoms of an angioma of the skin in the form of a venous lake (a type of venous malformation) - tumor-like papules of various forms of bluish, red or purple color with localization on the lips or eyelids (in children); in old age (65 years and older), they appear on the ears and are more common in men.

Spider-like skin angioma(with a red papule in the center and visible capillaries diverging in different directions) is often defined by dermatologists as stellate angioma, vascular spider or telangiectasia. They account for up to 40% of all vascular malformations. This angioma is localized along the superior vena cava on the face, neck, hands and forearms, on the upper part of the chest in 10-15% of healthy adults and children. Spider angioma is prone to regression: it can gradually decrease in size, turn pale, and eventually disappear altogether and appear only in the cold or at elevated body temperature.

Such "spiders" can appear in pregnant women, as well as in women using hormonal contraceptives, which may be associated with increased levels of estrogen. As experts note, the presence of more than three spider angiomas on the skin may be a sign of liver pathology (a third of patients with liver cirrhosis have similar "marks" on the skin), and also indicates the likelihood of esophageal varicose veins.

Symptoms of cavernous skin angioma, which are most often called hemangiomas, is the presence in the epidermis of a cyanotic or purple node with an uneven surface; when probing, the formation is hot, and when pressed, it becomes paler. It tends to grow.

Angiomas of the cavernous type include a congenital red birthmark, called Strawberry nevus or nevus vascularis. The first signs may appear several weeks after the birth of the baby in the form of a red spot (on the face, head, back and chest). The mass grows rapidly (sometimes up to several centimeters) until about one year of age, and at this stage it looks like a bright red tumor. Then growth stops, and after about a year, a slow regression begins with a color change to bluish gray. In 50% of cases, such a mole disappears by the age of 5, in 90% by 9; in its place, the formation of a whitish scar is possible. But a large strawberry nevus has negative consequences in the form of an increase in the level of platelets in the blood, which can lead to heart failure.

Diagnostics of the angioma of the skin

Skin angioma is usually diagnosed during the examination of the patient by a dermatologist, including using a dermatoscope. And for most skin pathologies of this type, there is no need for clinical trials. So tests are usually not required.

However, when a pathological change in the underlying tissues is detected, instrumental diagnostics of ultrasound scanning (ultrasound) of the vascular formation is necessary.

In more difficult cases, when the color and size of a mole or birthmark changes, which are atypical for a particular type of angioma, with bleeding formation, a full examination is carried out with the delivery of all tests. In case of uncertainty in the diagnosis (for example, if nodular melanoma or basal carcinoma is suspected), differential diagnosis is carried out using biopsy and histological examination of the tissue of the formation, angiography, computed tomography (CT) or magnetic resonance imaging (MRI).

Treatment of angioma of the skin

Dermatological angioma in most clinical cases does not require treatment; in addition, with the antenatal nature of the pathology, the treatment of skin angioma is very problematic. A typical case involves making a diagnosis, explaining to the patient (or parents of children with various birthmarks), the causes and clinical characteristics of vascular formation and subsequent monitoring of its condition.

Surgical treatment of angiomas of the skin is carried out if the patient is concerned about his appearance, the formations cause discomfort or are in an area that is easily touched, which can lead to bleeding. Such treatment consists in their removal with the help of:

  • pulsed laser (PDL);
  • moxibustion with high-frequency electric current (diathermocoagulation or electrocautery);
  • fulguration (non-contact cauterization with plasma);
  • cryodestruction (freezing a protruding nodular angioma with liquid nitrogen);
  • puncture and administration of sclerosing substances (alcohol);
  • surgical excision.

For drug therapy of cutaneous angiomas, medications such as:

  • systemic corticosteroids (injections of Prednisolone, Hydrocortisone, etc. into the lesion site contribute to growth arrest and accelerated regression of angioma);
  • interferon α-2a or α-2b (intramuscular administration reduces the proliferation of skin angioma);
  • drugs that inhibit angiogenesis block vascular endothelial growth factor (VEGF) and are used for pathological neovascularization.

The herbal treatment recommended for getting rid of birthmarks has not passed any tests and clinical trials, so you do not need to smear a red mole, nevus vascularis with celandine juice or aloe, and a wine birthmark with wormwood decoction. It is unlikely that birch wood ash or a mixture of apple cider vinegar with honey and black pepper will help here.

Tea tree oil, which is quite effective for fungal infections of the skin and nails, is also powerless. In addition, it can cause an allergic reaction.

Angioma of the skin can have different localization and often causes certain cosmetic discomfort. But this does not affect the general state of health, and prevention of this pathology is impossible, since there are no ways to prevent its occurrence. See a doctor, see your child with a specialist, and follow medical advice.

Sturge-Weber syndrome causes a port-wine stain usually on the forehead and upper eyelid in the region of the 1st or 2nd branch of the trigeminal nerve. Leptomeningeal angioma occurs in 90% of patients when the spot involves the upper and lower eyelids on one side, but only in 10-20% of cases when only one eyelid is damaged. Neurologic complications include seizures, focal neurologic deficits (eg, hemiparesis), and mental retardation. The disorder can also lead to glaucoma and vascular malformations, which can increase the risk of cardiovascular events (eg, stroke, thrombosis, venous occlusion, heart attack). The syndrome is not inherited; the etiology is not clear. Types.

There are 3 types.

  • Type I: port wine stain and brain angioma.
  • Type II: port wine stain without cerebral angioma.
  • Type III: angioma of the brain without port wine stain.

Symptoms and signs of Sturge-Weber syndrome

Port wine stains can range in size and color from light pink to deep purple.

Seizures occur in about 75-90% of patients and usually begin at 1 year of age. The seizures are usually focal but may become generalized. Hemiparesis on the side opposite to the port wine stain develops in 25-50% of patients. About 50% of patients have mental retardation and more than half have some learning difficulties. Development may be delayed.

The eyeball can be enlarged and protrude from the orbit (buphthalmos).

Diagnostics of the Sturge-Weber syndrome

The diagnosis is suggested by the presence of a characteristic port wine stain. CT and MRI are used to check for leptomeningeal angioma. A neurologic examination is done to identify neurologic complications.

Treatment of Sturge-Weber syndrome

Treatment focuses on symptoms. Anticonvulsants and drugs are used to treat glaucoma. Small doses of acetylsalicylic acid are often prescribed to help prevent strokes. Selective photothermolysis can lighten the port wine stain.

In 1879 W.A. Sturge reported a 6-year-old girl with buphthalmos, hemiparesis and angioma of the facial skin, which also involved the mucous membranes of the lips, gums, palate, pharynx and uvula. F.P. Weber (1922) during X-ray examination of a patient with angioma of the facial skin and hemiplegia revealed intracranial calcifications in him. Sturge-Weber-Krabbe syndrome includes the following clinical signs:

Epidemiology and Genetic Research. The disease is usually sporadic. There are known casuistic cases of the development of the disease in several members of the same family. It is not possible to explain the mechanism of inheritance using Mendel's laws.

Ophthalmic manifestations. Changes in the eyes are very diverse, the degree of their severity varies considerably. These include angiomatosis of the eyelids, prominant convoluted conjunctival and episcleral vascular plexuses, ipsilateral iris heterochromia, choroidal hemangioma, and glaucoma.

Choroidal angioma occurs in approximately 40 % patients with Sturge-Weber-Krabbe syndrome. In some of them, choroidal angioma may be local (limited), representing a red-orange neoplasm in the posterior field. In most patients, a diffuse angioma of the choroid is noted, spreading to all parts of the choroid, causing an ophthalmoscopic phenomenon called the "tomato ketchup" reflex (Fig. 11.14).


Diffuse angioma of the choroid is more often congenital and develops asymptomatically for some time. Both eyes are usually affected. Usually, visual disturbances appear at an age 6-12 years. Children with diffuse choroidal angioma usually have hyperopia, which may gradually increase.

Ophthalmoscopy in these cases reveals cystic maculopathy, diffuse deposits of solid exudate in the posterior pole (see Fig. 11.14), tortuosity of the retinal vessels, multiple arteriovenous communications, hyperplasia of the retinal pigment epithelium. Exudative retinal detachment often develops (Fig. 11.15). When ultrasound in children with diffuse angioma, the choroid records a significant thickening of the choroid, mainly in the posterior pole (see Fig. 11.15).


Glaucoma develops in 33 % patients with Sturge-Weber syndrome. The spread of angioma of the facial skin to the upper eyelid is traditionally considered to be an unfavorable symptom in the development of glaucoma in these patients. Meanwhile R.F. Stevenson and J.D. Morin, | (1975) noted that in patients with a nevus of the lower eyelid, glaucoma develops just as often as in the defeat of the upper eyelid. In some patients with hemangioma of the choroid with Sturge-Weber syndrome, the development of glaucoma may be associated with hyperemia of the ciliary body, causing hypersecretion of the intraocular fluid. Other reasons for the development of glaucoma in Sturge-Weber syndrome are abnormalities in the development of the trabecular network and arteriovenous communications of the anterior chamber angle, leading to impaired outflow of intraocular fluid.

Systemic manifestations. Congenital angioma of the facial skin ("flamed nsvus", or "port wine stain") is observed in almost all patients with Sturge-Weber disease (see Fig. 11.13). Angioma is usually located along the branches of the trigeminal nerve, but sometimes extends to the cervical segments.

Focal or generalized motor paroxysms are observed in 80 % patients with Sturge-Weber-Krabbe syndrome. Some may have mental retardation. These disorders are caused by a slowdown in the speed of blood flow in the affected pia mater, which leads to anoxia of the underlying area of ​​the cerebral cortex. Vascular malformations in the occipital lobes can cause themanoptical defects in the visual field.

A typical radiological sign for angiomatosis of the brain is the presence of calcifications in the leptomeningeal space, localized mainly in the parieto-occipital region (Fig. 11.16).


Ophthalmic rehabilitation. In the treatment of patients with Sturge-Weber-Krabbe syndrome and glaucoma, both medical and surgical methods are used. A frequent intraoperative complication of fistulizing interventions in patients with Sturge-Weber-Krabbe syndrome is massive choroidal effusion.

For local (limited) angomas, choroids use laser coagulation and cryotherapy, but, unfortunately, these methods are palliative, allowing only to slow down the progression of the disease for a while. Nevertheless, in a number of cases, the use of laser coagulation makes it possible to control the accumulation of subretinal fluid for a long time and restrain the development of exudative retinal detachment, while preserving object vision in patients.

Laser coagulation is indicated for patients with limited angioma of the choroid of extrafoveal localization, which in some cases may be combined with exudative retinal detachment extending to the fovea. Before laser coagulation, PAH is necessary to accurately determine the boundaries of angioma. For coagulation of limited choroid angiomas, argon green, neodymium: YAG green or diode lasers are usually used. Coagulation parameters: exposure 0,1-1,0 s, spot diameter 200-50 0 μm, power 200-800 μV. The parameters of laser coagulation are selected in such a way as to obtain coagulates of the II-III degree (a white focus with clear or sharply black borders). Retinal coagulation is carried out directly above the angioma, while the distance between adjacent coagulates does not exceed their diameter. After laser coagulation within 1-2 weeks, there is a complete or partial resorption of the subretinal fluid and adherence of the detached retina.

RAnand et al. used xenon or laser coagulation in 71 patient ( 71 eye) with limited alal glaucoma. Have 55 (78 % ) of patients, choroidal angioma was combined with exudative retinal detachment. After the first course of treatment, complete resorption of subretinal fluid was achieved in 79 % cases. However, 40 % of patients, reacumulation of subretinal fluid was noted, which required additional coagulation, as a result of which the authors were able to achieve complete adherence of the detached retina in all cases. After photo- or laser coagulation, an increase in visual acuity was observed in 20 % patients, stabilization or slight fluctuations - in 80 % ... When re-examining patients in whom, after treatment, visual acuity exceeded 20/200 , across ] 0 years, it was found to decrease to 20/200 and below in 36 % cases.

The most effective methods of treating patients with both local and diffuse angiomas of the choroid are radiation and brachytherapy, as well as external targeted non-contact irradiation. H. Schilling et al. (1997) reported the successful use of external targeted non-contact irradiation for the treatment of diffuse choroid angioma in 12 sick ( 15 eye) with Sturge-Weber syndrome. In 6 eyes, before treatment, neovascular glaucoma was also detected, which could not be stopped with medication. The total absorbed dose for the course of treatment was 20 Gr. After treatment, all patients showed a decrease in the height of the tumor, complete or partial resorption of the subfluid, and adherence of the detached retina. As a result of treatment, an increase in visual acuity by two or more lines of the table was noted by the authors in 46,6 % eye, stabilization of visual acuity or its slight fluctuations - in 53,4 % ... Intraocular pressure in all patients with neovascular glaucoma reached normal levels. The observation period for patients was on average 5,3 of the year. There were no cases of relapse of the disease.

In patients with diffuse choroid angioma and total retinal detachment, radiation therapy is carried out for organ-preserving purposes to prevent the development of neovascular glaucoma. For cosmetic purposes, laser therapy of angioma of the eyelid skin can be performed.

A flaming nevus is a congenital birthmark on the skin of the face, neck, and torso. It is a vascular pathology. It doesn't go away by itself. It is well treated with a laser.

Synonyms: wine stain, port wine stain, fiery nevus, capillary angiodysplasia of the face, flaming nevus.

Flaming nevus in Mikhail Gorbachev

Flaming nevus

Causes

The main cause of port port wine stains is intrauterine vascular development of the skin. The vessels of the skin in the area of ​​the spot are dilated, but do not have tumor growth, as in hemangioma. This condition in medicine is called malformation, or dysplasia, that is, a developmental disorder.

Attention: a flaming nevus is not a hemangioma or cancer !!! This condition is not life threatening for the child.

Symptoms and manifestations

The main and main symptom of a fiery spot is that red or red-cyanotic spots of irregular shape appear on the face, neck, and rarely on the body of a newborn. When diascopy (finger pressure) - the spot turns pale.


These spots:

  • do not itch, no itching,
  • do not get inflamed
  • do not bleed
  • do not pass on their own,
  • grow in size with the child,
  • with age, they may become more bluish, nodules may appear in the center of such spots (these are angiofibromas).

Capillary angiodysplasia in a woman

Diagnostics

Diagnosing a flaming nevus is not difficult.

But there is a big BUT:

In some cases, port wine stains on a child's face can be combined with serious congenital pathologies of internal organs (brain or spinal cord, eyes, dwarfism or gigantism of the limb).

Therefore, the pediatrician during the initial examination of such a newborn should first of all exclude the pathology of the internal organs. The doctor should prescribe additional examinations and consultations of related specialists (ophthalmologist, neurologist). And if such a pathology is not found, then you can calm down and start treating the very wine stain on the face.

Even today, children with wine stains on their skin are often misdiagnosed as hemangiomas. If the hemangioma is very difficult to cure, which leads to a psychological deformation of the child's personality. Either capillary angiodysplasia, or a flaming nevus, or a port wine stain can be successfully treated in several procedures. And subsequently, children forget about such a pathology, no one teases them, their personal life is successfully developing.

Treatment

  • cauterize with liquid nitrogen -
  • use a conventional laser -
  • to carry out hardening of blood vessels with alcohol

Attention: flaming nevus, port wine stains - this pathology is very successfully treated. If a dermatologist told you - humble yourself, this is for life - do not believe him. Change your dermatologist.

In the past 20 years, all over the world, treatment of flaming nevus has been carried out using a laser.

Attention: only a pulsed dye laser (so-called vascular laser) can be used. All other lasers can burn the baby's face and cause scarring.

The mechanism of action of a pulsed dye laser: a laser beam of a certain power is emitted within a few milliseconds. A certain laser wavelength leads to heating of the capillaries (vessels) of the skin in the spot area. Vessels stick together. Blood does not flow through them. As a result, the stain becomes lighter.
The skin itself is not affected. There is no skin burn - which means there are no scars on the skin.

Can you use folk remedies?

You can, there will be no harm. But they WILL NOT HELP !!!

When should treatment start?

Already in the first months of life. The older the child, the larger, darker, and more difficult the stain becomes.

How many procedures will you need?

From 1 to 5 depending on the size and color of the spot. The interval between procedures is 2-4 weeks.

Is anesthesia required?

Depends on the age of the child and the location of the spot. Babies are given general anesthesia.

We are watching a video of how children with wine stains are treated at the Russian Cancer Center:

Unna's nevus

Unna's nevus is a red birthmark on the face, nape and neck of newborns. It occurs in 30-40% of newborns. Passes by itself. No treatment required.

Synonyms: stork bite (or kiss), birthmark, salmon spot, red fish spot, angel's kiss, occipital nevus, disappearing spot, telangiectatic nevus.

ICD10 code: Q82.5 (congenital non-neoplastic nevus)

Unna's nevus in a child


Causes

Causes of Unna's nevus: expansion of capillaries on the scalp during childbirth. A number of researchers believe that this is caused by temporary fetal hypoxia, that is, a lack of oxygen during childbirth. The pressure of the mother's pelvic bones on the baby's scalp is also an important factor. Recall that a baby's head is the most voluminous part of the body during childbirth.

Attention:"Stork's kiss" or Unna's nevus is not a hemangioma !!!
This is a benign variant of a flaming nevus. That is, over time, this stain goes away on its own, without treatment.

Symptoms and clinic

Symptoms of Unna's nevus:

  • a pink or reddish spot on the skin of the nose, bridge of the nose, forehead, eyelids, upper lip, neck, occiput, sometimes on the sacrum,
  • the spot is flat, does not rise above the adjacent skin,
  • a spot of irregular shape, with brighter areas of passing vessels in the center (so-called telangiectasia),
  • when pressed with a finger (diascopy), the stain turns pale at the point of pressure,
  • when straining, crying a child, the stain becomes bright,
  • no itching, no itching, no pain.

Treatment

No treatment required. It passes on its own in the first months, sometimes in the first years of a child's life.

The prognosis is favorable.

If the stain does not go away with age, after 3-5 years, the patient should be directed to remove the stain with a dye laser (vascular laser).

Folk remedies?

Don't help !!! The main factor in the speedy healing of Unna's spot is a calm, stress-free regimen for an infant.

Attention: if the doctor did not answer your question, then the answer is already on the pages of the site. Use the search on the site.

33-year-old Katie Piper, who practically lost her face of the sulfuric acid poured on her, took part in a charity project. The TV presenter and model invited four British women with various serious skin problems and helped them transform with makeup.

Women all over the world struggle with self-doubt. This battle against their own complexes can be even more difficult for those who suffer from rosacea, vitiligo, or whose face is covered with scars and scars. British TV presenter Katie Piper, who was doused with sulfuric acid, decided to draw attention to this topic. She invited four women with skin problems to one of London's beauty salons to show how you can change yourself with makeup.

Katie wanted to prove that cosmetics can be used as a tool to boost self-esteem, and not just to hide flaws. “My face is a unique canvas. I can proudly walk without makeup at all, ”Piper said in an interview.

The dramatic transformations of the four heroines of the TV presenter's project will be shown in the documentary "Katie Piper: Face to Face", which will air in mid-April.

Fille: scars

Fille, 23, was injured in a car accident two years ago while volunteering in Ghana. Makeup artists gave the following beauty advice to Phil: “Start your makeup with moisturizer, and apply the foundation with a beauty blender. This will "hammer" the product into the skin and create an even coverage without visible scars or dents. "

Rochelle: Vitiligo

Rochelle was diagnosed with vitiligo when she was just 11 years old. At school, classmates bullied her for white spots on her skin. Now 27-year-old Rochelle prefers not to wear makeup because she doesn't want to hide her natural beauty. But now she is ready to experiment. With the help of the concealer, the makeup artists managed to completely hide the traces of the disease, but Rochelle herself admitted that she was unlikely to be able to do such a make-up for herself every day before leaving the house.

Lisa: Port wine stain

Lisa was born with a unique skin defect called a port wine stain. On the affected area of ​​the face, an accumulation of dilated capillaries appears, forming a red spot, which can be of different sizes and different shades - from light pink and red to dark purple. When the makeup was finished, Lisa was simply stunned. "I'm going to cry. I thought that I hated my face, but now I realized that I could be different, and that's great! ”- she said.

Sanna: rosacea

Sanna was diagnosed with rosacea last September. The girl admitted that the disease affected her relationship with business partners, and now she is very worried about what people think of her. Seeing the results of her transformation, she praised the makeup artists for their excellent work: "Thank you, my red spots on my cheeks have practically disappeared, it's amazing!"

The film will also tell the story of Katie Piper herself. She fell victim to her abusive ex-boyfriend, Daniel Lynch, who hired an accomplice and splashed sulfuric acid in the model's face. As a result of the attack, Piper lost her eyelids, most of her nose, and part of her ear. Her facial skin was eaten away so that the skull was visible. She spent seven weeks in the hospital. After major surgery, Katie remained in a coma for 12 days. Piper lost 38 kg, and for a while she was injected with food through the catheter. Then for two years, 23 hours a day, she wore a special plastic mask to keep scars to a minimum. In total, the girl underwent about 100 operations to restore her facial skin. She now runs a charitable foundation and helps thousands of women with similar problems.