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Dermatology > DISEASES OF THE VESSELS
Nevus Araneus (Spider Nevus)
Article Last Updated: Feb 21, 2007
AUTHOR AND EDITOR INFORMATION
Section 1 of 10  
Author: Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Mark A Crowe is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society
Editors: Carrie L Kovarik, MD, Assistant Professor, Department of Dermatology and Dermatopathology, University of Pennsylvania School of Medicine; Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center; Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center; Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Author and Editor Disclosure
Synonyms and related keywords:
spider angioma, spider nevus, vascular spider, spider-like capillary telangiectasis
Background
Spider angiomas are common, benign, acquired lesions present in 10-15% of healthy adults and young children. One lesion, or occasionally, a small number of lesions, develops in children or adults. Lesions are found most commonly on the face, neck, upper part of the trunk, and arms. In young children, spider angiomas are common on the backs of the hands and fingers.
Most lesions are unrelated to internal disease. Many women develop lesions during pregnancy or while taking oral contraceptives. These lesions are asymptomatic and usually resolve spontaneously 6-9 months after delivery or after discontinuing oral contraceptives. Numerous prominent spider angiomas are observed in patients with significant hepatic disease.
A spider nevus consists of a central arteriole with radiating thin-walled vessels. Compression of the central vessel produces blanching and temporarily obliterates the lesion. When released, the threadlike vessels quickly refill with blood from the central arteriole. The ascending central arteriole resembles a spider's body, and the radiating fine vessels resemble multiple spider legs.
Pathophysiology
Cutaneous vascular anomalies may be classified into the following categories: hamartomas, malformations, dilatations of preexisting vessels, hyperplasias, benign neoplasms, and malignant neoplasms. Spider angiomas are not vascular proliferations but occur as a result of the dilation of preexisting vessels.
Frequency
United States
Young children and pregnant women most frequently exhibit lesions. In pregnant women, palmar erythema usually is present. Spider angiomas are common in otherwise healthy children and are present in 10-15% of healthy adults and young children.
International
Frequency is presumed to be similar to that in the United States.
Mortality/Morbidity
Spider angiomas are asymptomatic benign lesions. When extensive, they may be associated with significant underlying internal pathology. Spider angiomas also may produce significant cosmetic concerns in some patients.
Race
No racial predilection is reported, but lesions are more apparent in light-skinned patients.
Sex
Young children of both sexes and pregnant women most frequently exhibit lesions.
Age
Benign solitary spider angiomas most commonly occur in school-aged children. Almost one half of children may develop a spider angioma at some point. Spider angiomas also are common in women of childbearing age in association with pregnancy or oral contraceptives.
History
- Lesions are asymptomatic and acquired.
- Rarely, patients report bleeding from a spider angioma following minor trauma.
- Ask female patients if they are pregnant, using hormonal supplements, or taking oral contraceptives.
- Inquire about patient history of alcohol abuse.
- Ask patients if they are taking medications that may result in liver damage.
Physical
- Spider angiomas usually are bright red with a small (1 mm), central, red papule surrounded by several distinct radiating vessels. The entire lesion usually is 0.5-1 cm in diameter.
- Pressure on the lesion causes it to disappear. Blanching is replaced by rapid refill from the central arteriole when pressure is released. Occasionally, pulsation of the central papule is noted.
- Lesions occur most commonly on the face, below the eyes, and over the cheekbones. Other common sites include the hands, forearms, and ears.
- Pregnant women and individuals with liver disease may demonstrate palmar erythema.
- Patients with significant internal disease may exhibit numerous prominent lesions over the trunk and face.
- Examine patients with extensive lesions for palmar erythema, pallid or white nails with distal hyperemic bands, splenomegaly, ascites, jaundice, and asterixis.
Causes
- Rapid development of numerous prominent spider angiomas may occur in patients with hepatic cirrhosis, malignant liver disease, and other hepatic dysfunctions. A common characteristic is an elevated blood estrogen level.
- When spider angiomas occur in association with palmar erythema and pallid nails with distal hyperemic bands, consider cirrhosis of the liver. Patients with liver disease may manifest additional symptomatology, including splenomegaly, ascites, jaundice, and asterixis.
- Children with liver disease rarely have large numbers of spider angiomas. Although the finding of 5 or more spider angiomas is more common in liver disease, many normal children also have one or more of these lesions.
Cherry Hemangioma
Insect Bites
Other Problems to be Considered
Telangiectatic mats (flat patches of tiny vessels of uniform size with no central vessel)
Spider telangiectasia has been used to describe leg telangiectases, most commonly appreciated in women; therefore, it cannot be considered synonymous with nevus araneus.
Lab Studies
Evaluate patients with extensive lesions for underlying liver disease.
Other Tests
Confirm diagnosis by observing the classic refill pattern from the central vessel outwards. This refill pattern is seen following compression and release of the lesion. Usually, no other testing is required.
Procedures
In the rare cases when diagnosis is questionable, consider skin biopsy.
Histologic Findings
A central ascending arteriole ends in a thin-walled ampulla just below the epidermis. This ampulla feeds thin delicate arterial branches that radiate peripherally into the superficial dermis. Usually, no significant inflammatory changes are noted. Glomus cells have been reported in the wall of the central arteriole.
Medical Care
- In children, treatment usually is not necessary, and lesions resolve spontaneously; however, complete resolution may require several years.
- In young women, lesions often resolve spontaneously within 6-9 months after the birth of a child or after discontinuing oral contraceptives.
- Numerous lesions associated with liver disease may improve or resolve if the liver recovers adequate function or if a liver transplant is performed.
Surgical Care
- Electrodesiccation and laser treatment both can be effective for bothersome facial spider angiomas. Although the risk of a small scar may be slightly higher with electrodesiccation, good results generally are achieved with either electrodesiccation or laser. Currently available laser systems may eliminate the lesion completely or achieve only partial clearing. Occasionally, lesions recur.
- Local anesthesia prior to therapy is optional in adults but advisable in children. Intradermal injection of 0.1-0.2 mL physiological saline solution produces brief complete anesthesia of the site and does not sting on injection. This represents a viable alternative to lidocaine.
- The central vascular papule has very few nerve endings. Rather than intradermal anesthesia injection, a 30-gauge needle can be inserted directly into the central papule. Anesthesia is flushed into the spider angioma, producing less pain.
- Usually, disappearance of the spider angioma follows electrodesiccation. Recurrences are common.
- To perform electrodesiccation, move the blood out of the spider by pressing firmly on the lesion. With continuous pressure, slightly move the finger to one side to expose the central arteriole. Then, gently electrodesiccate the central arteriole. If the arteriole is destroyed, radiating capillaries may not fill. Incompletely destroyed lesions may recur. Vigorous desiccation may cause a pitted scar.
Deterrence/Prevention
No preventive measures are known.
Complications
No significant complications are associated with spider angiomas; however, cosmetic issues may be of significant concern to some patients or to parents.
Prognosis
When not associated with liver disease, expect gradual complete resolution.
Medical/Legal Pitfalls
Failure to recognize numerous spider angiomas as a sign of significant liver disease
| Media file 1:
Large spider angioma on the left cheek of a child. |
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Media type: Photo
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| Media file 2:
The spider angioma has been compressed and is refilling rapidly from the central vessel (same patient as in Media File 1). |
 | View Full Size Image | |
Media type: Photo
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| Media file 3:
A spider nevus consists of a central arteriole with radiating thin-walled vessels. Compression of the central vessel produces blanching and temporarily obliterates the lesion. When released, the threadlike vessels quickly refill with blood from the central arteriole. The ascending central arteriole resembles a spider's body, and the radiating fine vessels resemble multiple spider legs. |
 | View Full Size Image | |
Media type:
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Nevus Araneus (Spider Nevus) excerpt Article Last Updated: Feb 21, 2007
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