Skin Disorders Guide

Diagnostic Hallmarks

1. Distribution - face, upper trunk, and proximal arms
2. Central feeder vessel with arborizing telangiectatic vessels
3. Association with liver disease and hormones

Clinical Presentation

The central feeding arteriole is a macule (or very small papule) 1 to 2 mm in diameter. Multiple small telangiectatic vessels (”legs”) radiate outward from the central vessel. Pressure on the central vessel causes collapse and disappearance of the surrounding vessel (”legs”). When the pressure is applied carefully enough, pulsations can be noted in the central arteriole.

Multiple lesions on the face, upper trunk, and proximal arms are found in some patients with significant liver disease, especially that resulting from alcoholic cirrhosis. One or two lesions in a similar distribution can be present in women as a normal finding; the tendency to develop these is enhanced during pregnancy and when use of oral contraceptives is begun. Children (both boys and girls) may develop one or two lesions on the face several years prior to onset of puberty.

Telangiectatic “mats,” similar to spider angiomas but lacking the central arteriole, occur in some forms of scleroderma (the CREST syndrome) and in hereditary hemorrhagic telangiectasia of Osler, Weber and Rendu.

Pathogenesis

The cause is unknown, but estrogens seem to play, at. the very least a permissive role for the development of spider angiomas. The estrogenic changes that occur in alcoholic cirrhosis probably explain their appearance in that setting.

Course and Prognosis

Spider angiomas that. occur in adult. life are usually persistent. Those that occur prepubertally disappear without a trace after 1 or 2 years.

Therapy

A fine electrosurgical needle (”eat’s whisker”) can be touched to the central feeding vessel. This obliterates the entire lesion, but often there is recurrence some months later.