Telangiectasias are small dilated superficial blood vessels that are blanchable with pressure. These lesions are more common in fairskinned individuals with chronic sun exposure and rosacea. Spider telangiectasia (nevus araneus) is seen most commonly on the face and upper trunk in women and children. These are small telangiectasias radiating from a central arteriole. Acquired lesions may appear in relation to liver disease, such as hepatitis and cirrhosis, or in relation to changes in estrogen metabolism. The most common cause of acquired facial telangiectasia is chronic ultraviolet rays exposure. Other causes of facial telangiectasia include connective tissue disease, prolonged use of topical corticosteroids, rosacea, and postrhinoplasty “red nose” syndrome.

Telangiectasias can also be a manifestation of systemic diseases. Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia or HHT) is an autosomal dominant disease with clinical manifestations such as matlike telangiectasias on the face, tongue, hands, and feet in the context of recurrent epistaxis or internal gastrointestinal bleeding. CREST syndrome (calcinosis cutis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) patients often develop hyperpigmentation on sun-exposed areas. Progressive systemic sclerosis may present with telangiectasia early in the course of disease. Sclerotic changes initially involve face and extremities, but eventually involve larger areas of the body.

See Figures 43-1 and 43-2. Persistent dilations of small capillaries are visible as bright red lines or net-like patterns on the skin. Spider telangiectasias consist of a bright red central popular punctum with radiating branches, resembling a spider. The central arteriole may be pulsating, but the radiating telangiectasia blanches with pressure. Patients with multiple telangiectasias of the face may complain of generalized facial erythema.

If a patient presents with blood in the stool, anemia, and red telangiectasias on his lips and fingers, the most likely cause is HHT

Stay updated, free articles. Join our Telegram channel

Join