BASICS
DESCRIPTION
- Benign dilated arteriole with a characteristic spider-like appearance where the arteriole is close to the surface of the skin at a central point (spider body) and has radiating capillaries (spider legs)
- Distribution is that of the superior vena cava. On adults the face, neck, upper trunk, and arms are typically involved. In children, they are most often seen on the fingers and hands.
- Tend to be permanent in adults, may fade in children and following pregnancy
EPIDEMIOLOGY
Occurs normally in adults and young children; is also associated with liver disease and pregnancy
Incidence
- Present on 10 " 15% normal adults and up to 40% of young children, although many of these fade.
- No predominant sex
- No predominant race. However, lesions are easier to see in patients with lighter skin.
- Pregnant women and children are most commonly affected (1).
- Pregnancy considerations: occurs in 60 " 70% of pregnant white women and 10% of pregnant dark-skinned women (2)
- More common in pregnant woman in their 1st and 2nd trimesters of pregnancy (2)
- A reported 38% of school-aged children have one to four spider angiomas, with increased numbers of lesions with age.
ETIOLOGY AND PATHOPHYSIOLOGY
- Spider angiomas are classified as primary (cause unknown) telangiectasias.
- Probably stimulation via elevated estrogen concentrations as seen in pregnancy and liver disease
- In liver disease, estrone, which derives from the androgen androstenedione, is elevated.
RISK FACTORS
- Pregnancy: Lesions that arise with pregnancy may resolve within months of delivery.
- Liver disease (cirrhosis)
- Hormonal contraception use, cryosurgery, laser, or electrosurgery, and topical steroid use may predispose to formation of telangiectasias
GENERAL PREVENTION
None
DIAGNOSIS
Diagnosis is mainly clinical, based on history and physical exam.
HISTORY
- Patient may bring to attention of physician given concerns over medical implications or cosmetic appearance.
- Painless
- Once formed, tend to be permanent
- Rarely bleed
PHYSICAL EXAM
- Localized network of dilated capillaries arising from central arteriole with "spider " appearance.
- On adults, the face, neck, upper trunk, and arms are typically involved. In children, they are most often seen on the fingers and hands.
- Disappear when pressure is applied, return when pressure is released
DIFFERENTIAL DIAGNOSIS
- Ataxia telangiectasia
- Generalized essential telangiectasia
- Unilateral nevoid telangiectasia syndrome
- Basal cell carcinoma
- Cushing syndrome
- Dermatomyositis
- Lupus erythematosus
- Metastasis
- Necrobiosis lipoidica diabeticorum
- Poikilodermas
- Pseudoxanthoma elasticum
- Rosacea
- Telangiectasia macularis eruptiva perstans
- Xeroderma pigmentosa
DIAGNOSTIC TESTS & INTERPRETATION
History and physical exams suggest the diagnosis; however, biopsy may be performed for confirmation or in atypical cases.
Initial Tests (lab, imaging)
None
TREATMENT
Treatment is largely for cosmesis; however, medical justification may arise if angiomas bleed frequently or cause physical irritation.
GENERAL MEASURES
Treat underlying condition as appropriate. More than three is associated with liver disease and potentially esophageal varices (1).
MEDICATION
None
SURGERY/OTHER PROCEDURES
- Electrodesiccation of central arteriole may resolve. Provider must take care to avoid aggressive treatment, which may lead to a pitted scar.
- Laser treatment can usually eradicate lesions (2).
ONGOING CARE
COMPLICATIONS
- Monitor for resolution in children, following pregnancy, after discontinuation of hormonal contraception, or treatment of liver disease (e.g., transplant).
- Evaluate increasing numbers as clinically appropriate.
REFERENCES
11 Udell JA, Wang CS, Tinmouth J, et al. Does this patient with liver disease have cirrhosis? JAMA. 2012;307(8):832 " 842.22 Geronemus RG. Treatment of spider telangiectases in children using the flashlamp-pumped pulsed dye laser. Pediatr Dermatol. 1991:8(1):61 " 63.
ADDITIONAL READING
- Becher GL, Cameron H, Moseley H. Treatment of superficial vascular lesions with the KTP 532-nm laser: experience with 647 patients. Lasers Med Sci. 2014;29(1):267 " 271.
- Li CP, Lee FY, Hwang SJ, et al. Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function. Scand J Gastroenterol. 1999:34(5):520 " 523.
- Sharma A, Sharma V. Giant spider angiomas. Oxf Med Case Reports. 2014;2014(3):55.
CODES
ICD10
I78.1 Nevus, non-neoplastic
ICD9
448.1 Nevus, non-neoplastic
SNOMED
Spider nevus (disorder)
CLINICAL PEARLS
- Spider angiomas are diagnosed primarily on "spider-like " clinical appearance with prominent central arteriole and network of surrounding capillaries.
- Tend to be permanent in adults, may resolve in children
- Higher in high estrogen states such as pregnancy and liver cirrhosis