Spider Angioma - Causes, Clinical Features, Diagnosis & Treatment

Introduction:

Spider angioma, also called spider telangiectasia, is a condition where a reddish-purple lesion is seen on the skin as a result of the dilatation of blood vessels. It derives its name because of the characteristic spider-like appearance of the lesion. It has a central red papule (raised red plaque) from which fine red lines run outwards, radiating from the central papule. It is characterized by an abnormal dilation of an arteriole below the surface of the skin, which appears as a red spot with extensions radiating from the center that appears as a spider’s web. They can be solitary lesions or multiple in number.

What Is Spider Angioma?

Spider angioma is a vascular (related to blood vessels) lesion due to the dilation of blood vessels. Angioma means an abnormal growth or dilatation of blood vessels. Telangiectasia also means dilating capillaries that appear as red clusters, often resembling a spider, with a central papule and fine capillaries radiating from the central red dot. It is also called spider naevus and nevus araneus. It is an acquired vascular malformation that occurs when a muscle that is responsible for constricting or restricting the size of an arteriole fails, which causes the arteriole to dilate. Spider angioma is a cutaneous manifestation of underlying systemic conditions such as liver damage, pregnancy, rheumatoid arthritis, thyroid disorders, or malnutrition.

What Causes Spider Angioma?

The failure of the sphincter muscle found around an arteriole is responsible for the dilatation of the capillary. Spider angioma is the dilatation of a pre-existing central arteriole from which numerous small capillaries branch or radiate out.

The exact cause which triggers the dilation is not known. There are several possibilities, such as:

• Vasodilation is caused by alcohol consumption.

• Steroid hormones or sex hormone imbalance can be responsible for the development of spider nevi.

• Estrogen overproduction is seen in pregnancy or women taking oral contraceptives. It is seen in 60% of pregnant women.

Liver cirrhosis or some damage to the liver can cause spider telangiectasia, or it can cause inadequate metabolism of steroid hormones or elevated growth factors, which can, in turn, cause spider telangiectasia. In 95 % of the cases, chronic liver disease has been the cause of spider telangiectasia. It is primarily seen in patients who have alcoholic hepatitis or hepatopulmonary syndrome. These patients with alcoholic liver disease also have the highest incidence of mortality associated with spider nevi.

• Elevated growth factors such as primary fibroblast growth factor or vascular endothelial growth factor can be responsible for angiogenesis, which can give rise to spider nevi.

What Are the Clinical Features of Spider Telangiectasia?

• A spider angioma typically has three features: a central body, surrounding erythema, and legs. It usually appears as one to ten mm in diameter. It resembles a spider’s body, with the size decreasing towards the margins.

• Spider telangiectasia can be found on the face, neck, upper chest, hands, arms, and other sites. It is believed that it follows the distribution of the superior vena cava vein.

• A central dilated arteriole with radiating fine capillaries is the characteristic feature of spider telangiectasia; however, in some cases, the radial capillaries may be absent. They can also be star-shaped.

• The condition can vary in number and size; it tends to be larger and more in number in patients with chronic liver disorders. It is found in association with leukonychia, jaundice, confusion, fluid retention, and palmar erythema in patients with chronic liver disease.

• The lesions are usually asymptomatic but can bleed on trauma in some cases.

• Spider telangiectasia can affect any race and any age, but it is more easily visible in people with fair skin. A solitary lesion can be seen in 10% to 15% of the population, including adults and children.

• It can also be found in the oral mucosa or gastrointestinal tract.

• It is found that the temperature in the skin surrounding the nevus is at higher temperature than adjacent skin.

• Spider angioma can be classified from grades one to four, one indicating readily recognizable lesions and four indicating small lesions that require a hand lens.

How to Diagnose Spider Telangiectasia?

• Diagnosis is based on the typical clinical presentation of the cutaneous lesion. Pressure causes the radial capillaries to blanch or disappear, reappearing when the pressure is relieved.

• Spider telangiectasia is not to be confused with spider veins. Spider veins are blue-colored and occur due to dilation of the veins and are found on the thighs and lower legs and may be associated with varicose veins.

• The direction of the blood flow can be found by placing a glass side over the lesion and applying pressure, the pressure causes pallor, and the lesion reappears when it is released. This feature is not seen in any other forms of angiomas.

How to Treat Spider Telangiectasia?

Spider telangiectasia is often a symptom of an underlying systemic condition. The cutaneous lesion on its own is harmless and does not require any treatment.

If it causes any aesthetic concern, it can be removed by destroying the central arteriole, but this might lead to a scar formation. Spider telangiectasia can be removed by:

• Electrocautery.

• Cryotherapy.

• Intense pulsed light.

• Vascular laser.

• Surgical removal is also possible, but it will lead to scar formation.

It can be prevented by controlling alcohol intake and discontinuing the use of combined contraceptive pills if it causes spider nevi.

What Is the Prognosis?

Spider telangiectasia can have a variable prognosis. It persists in some while it disappears when the causative factor is removed, while in others, it can reappear even after successful treatment. The lesion often disappears within six months for women who can bring estrogen production under control or who stop using combined contraceptive pills. If the spider angioma is associated with pregnancy, it resolves spontaneously after birth. In young adults, it disappears as age progresses.

Conclusion:

Spider telangiectasia is a cutaneous lesion that arises due to the dilation of the arteriole, which resembles a spider’s body, with a central red papule and radiating fine lines. It is often a result of liver cirrhosis or chronic liver disease and overproduction of estrogen or steroid hormones. It is usually harmless and painless and does not require treatment unless it causes an aesthetic concern.