II. Definitions
- Telangiectasia (Spider Vein)
- Permanent dilation of small blood vessels (capillaries) near the skin surface or on the mucous membranes
- Lesions may appear on the Tongue, lips and Palate, Conjunctiva, nail beds or involve any skin surface
- Frequently located on the lower legs
III. Pathophysiology
- Venous reflux from underlying Varicose Veins
IV. Causes: General
- Inherited (Genetic Syndromes)
- Ataxia Telangiectasia or related conditions (e.g. Bloom Syndrome)
- Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome)
- Numerous other more rare genetic disorders with Telangiectasias exist
- Generalized essential Telangiectasia
- Uncommon cause of widespread Telangiectasia (esp. on legs), typically in adult women
- Acquired
- Trauma
- Malignancy
- Basal Cell Carcinoma
- Kaposi Sarcoma
- Merkel Cell Carcinoma
- Lymphoma (e.g. Cutaneous T-Cell Lymphoma, Invasive B Cell Lymphoma)
- Medications
- Calcium Channel Blockers (and other vasodilating medications)
- Sun-exposed areas
- Corticosteroids
- Associated with longterm use of either topical or Systemic Corticosteroids
- May also occur with intralesional Corticosteroid Injection
- Calcium Channel Blockers (and other vasodilating medications)
V. Evaluation: Localized Telangiectasias
- Papular Telangiectasia
- Cherry Angioma
- Angiokeratoma
- Basal Cell Carcinoma
- Angiofibroma
-
Macular Telangiectasia as Primary Lesions
- Skin Atrophy
- Broca's Telangiactasias
- Purpura Annularis Telangiectodes of Majocchi (Majocchi's disease)
- Absent Skin Atrophy
- High Estrogen State (e.g. Pregnancy)
- Unilateral Nevoid Telangiectasia
- Spider Nevi (Spider Angioma)
- Red, raised lesions on face, neck, arms and chest
- Occur in up to 67% of pregnancies and resolve postpartum in 75% of cases
- Elderly
- Costal Fringe
- Band of Telangiectasias along the anterolateral costal margins
- Costal Fringe
- Child and Teen
- Upper half of body
- Capillary malformation (e.g. Port-Wine Stain, Nevus Simplex)
- Lower half of body
- Angioma Serpiginosum
- Upper half of body
- HIV
- HIV-Related Telangiectasia
- High Estrogen State (e.g. Pregnancy)
- Skin Atrophy
-
Macular Telangiectasia as Secondary Lesions (associated with broader skin or systemic disorder)
- Skin Atrophy
- Sun Damaged Skin (Poikiloderma of Civatte)
- Longterm Topical Corticosteroid-related skin damage
- Radiation Therapy Induced Skin Changes
- Scleroderma
- Discoid Lupus (Telangiectoid Variant)
- Cutaneous T-Cell Lymphoma (Poikiloderma Atrophicans Vasculare)
- Angiolupoid Sarcoidosis
- Absent Skin Atrophy
- Skin Atrophy
VI. Imaging
- Venous Doppler Ultrasound
- Consider when venous reflux is suspected
VII. Management
-
Radiofrequency Surgery (Electrosurgery)
- Coagulation or Electrodesiccation of involved superficial vessels
- Laser Photorejuvenation
- Intense Pulse Light Therapy
- Sclerotherapy
VIII. Resources
- Telangiectasia (DermNetNZ)
- Telangiectasia (Wikipedia)