II. Definitions

  1. Telangiectasia (Spider Vein)
    1. Permanent dilation of small blood vessels (capillaries) near the skin surface or on the mucous membranes
    2. Lesions may appear on the Tongue, lips and Palate, Conjunctiva, nail beds or involve any skin surface
    3. Frequently located on the lower legs

III. Pathophysiology

  1. Venous reflux from underlying Varicose Veins

IV. Causes: General

  1. Inherited (Genetic Syndromes)
    1. Ataxia Telangiectasia or related conditions (e.g. Bloom Syndrome)
    2. Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome)
    3. Numerous other more rare genetic disorders with Telangiectasias exist
    4. Generalized essential Telangiectasia
      1. Uncommon cause of widespread Telangiectasia (esp. on legs), typically in adult women
  2. Acquired
    1. Rosacea
    2. Cirrhosis (e.g. Caput Medusa)
    3. Cushing Syndrome
    4. Pregnancy
    5. Scleroderma (Systemic Sclerosis)
    6. Chronic Cutaneous Lupus (CCLE, Discoid Lupus)
    7. Necrobiosis Lipoidica
    8. Carcinoid Syndrome
    9. Dermatomyositis
  3. Trauma
    1. Sun Damaged Skin
    2. Hypertrophic Scar
  4. Malignancy
    1. Basal Cell Carcinoma
    2. Kaposi Sarcoma
    3. Merkel Cell Carcinoma
    4. Lymphoma (e.g. Cutaneous T-Cell Lymphoma, Invasive B Cell Lymphoma)
  5. Medications
    1. Calcium Channel Blockers (and other vasodilating medications)
      1. Sun-exposed areas
    2. Corticosteroids
      1. Associated with longterm use of either topical or Systemic Corticosteroids
      2. May also occur with intralesional Corticosteroid Injection

V. Evaluation: Localized Telangiectasias

  1. Papular Telangiectasia
    1. Cherry Angioma
    2. Angiokeratoma
    3. Basal Cell Carcinoma
    4. Angiofibroma
  2. Macular Telangiectasia as Primary Lesions
    1. Skin Atrophy
      1. Broca's Telangiactasias
      2. Purpura Annularis Telangiectodes of Majocchi (Majocchi's disease)
    2. Absent Skin Atrophy
      1. High Estrogen State (e.g. Pregnancy)
        1. Unilateral Nevoid Telangiectasia
        2. Spider Nevi (Spider Angioma)
          1. Red, raised lesions on face, neck, arms and chest
          2. Occur in up to 67% of pregnancies and resolve postpartum in 75% of cases
      2. Elderly
        1. Costal Fringe
          1. Band of Telangiectasias along the anterolateral costal margins
      3. Child and Teen
        1. Upper half of body
          1. Capillary malformation (e.g. Port-Wine Stain, Nevus Simplex)
        2. Lower half of body
          1. Angioma Serpiginosum
      4. HIV
        1. HIV-Related Telangiectasia
  3. Macular Telangiectasia as Secondary Lesions (associated with broader skin or systemic disorder)
    1. Skin Atrophy
      1. Sun Damaged Skin (Poikiloderma of Civatte)
      2. Longterm Topical Corticosteroid-related skin damage
      3. Radiation Therapy Induced Skin Changes
      4. Scleroderma
      5. Discoid Lupus (Telangiectoid Variant)
      6. Cutaneous T-Cell Lymphoma (Poikiloderma Atrophicans Vasculare)
      7. Angiolupoid Sarcoidosis
    2. Absent Skin Atrophy
      1. Rosacea
      2. Mastocytosis
      3. Seborrheic Dermatitis
      4. Hereditary Hemorrhagic Telangiectasia

VI. Imaging

  1. Venous Doppler Ultrasound
    1. Consider when venous reflux is suspected

VII. Management

  1. Radiofrequency Surgery (Electrosurgery)
    1. Coagulation or Electrodesiccation of involved superficial vessels
  2. Laser Photorejuvenation
  3. Intense Pulse Light Therapy
  4. Sclerotherapy

VIII. Resources

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