This 40-year-old man has multiple family members in multiple generations with cutaneous and visceral telangiectasias, nose bleeds, and gastrointestinal bleeds. He is on chronic iron supplementation followed closely by otolaryngology to help manage recurrent nose bleeds which were severe enough to cause anemia. Some of his cutaneous lesions have become painful and many bleed with minimal trauma. Several cutaneous lesions were treated recently with the Nd:YAG laser with an energy fluence of 120 j/cm2, spot size of 5 mm, and pulse duration of 20 msec. For the larger and/or deeper lesions 2-3 pulses were stacked over 1-2 seconds.
multiple 2-4 mm partially blanching violaceous papules some with overlying crusts