Generalized Essential Telangiectasia Clinical Presentation

  • Author: David Green, MD, PA; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 10, 2011
 

History

  • The most commonly observed initial clinical presentation of generalized essential telangiectasia is telangiectasia on the feet, ankles, and distal legs. Subsequently, telangiectases appear more proximally on the lower extremities, and they also may develop on the upper extremities and trunk. In a report of 13 patients, 12 had involvement of the lower extremities. Occasionally, telangiectases first become apparent on the upper extremities or trunk.[2]
  • Bleeding from the ectatic vessels is rare.
  • Usually, no family history exists of a similar disorder; however, some familial cases have been reported.
  • Generalized essential telangiectasia is usually asymptomatic, but tingling burning or numbness is occasionally reported.
  • The age of onset is usually in the fourth or fifth decade, but symptoms may be observed in younger adults.
  • The progressive development of the telangiectases, without spontaneous regression, is the usual course.
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Physical

  • In generalized essential telangiectasia, dilated blood vessels represent capillary telangiectases (not venous), ie, they appear red or pink and are usually less than 0.2 mm in diameter, unlike venous telangiectases, which usually appear more blue in color and are greater than 0.2 mm in diameter.
  • Most often, generalized essential telangiectasia presents as numerous discrete pink and red capillaries, appearing punctate, linear, or as a lacework or syncytial network. Occasionally, discrete, well-circumscribed, red macules lend the skin a speckled appearance.
  • Capillaries are usually bilateral and are symmetrically distributed on the skin. When they are numerous enough to become confluent, the skin appears diffusely erythematous, and discerning individual telangiectases becomes impossible.
  • Telangiectases rarely protrude above the normal plane of the skin. Pressure on the skin readily displaces the blood, causing blanching; however, rapid refilling occurs.
  • On infrared photography, the underlying venous vasculature appears normal.
  • Even in the presence of significant cutaneous involvement, mucous membranes and conjunctivae are not usually affected, although extracutaneous involvement of the oral mucosa and conjunctiva has been reported.[3, 4, 5, 6, 7] No changes occur within the epidermis or dermis.
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Causes

  • Etiology and pathogenesis of generalized essential telangiectasia remain unknown.
  • Naturally occurring substances, such as estrogen, serotonin, or adrenal corticosteroids, have no known influence on the development or progression of generalized essential telangiectasia.[8, 9]
  • No reported association with varicose vein disease or other superficial or underlying deep venous insufficiency has been reported.
  • Localized absence of telangiectases under a wristwatch has been reported. This suggests that sun exposure or mechanical factors may influence the development of telangiectases, as is observed with ataxia-telangiectasia (Louis-Bar syndrome).
  • A patient reported with generalized essential telangiectasia, having multiple symmetrically distributed telangiectases on upper and lower extremities, had telangiectases covering an appendectomy scar; however, other scars associated with multiple unrelated surgical procedures had none.[10]
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Contributor Information and Disclosures
Author

David Green, MD, PA  Clinical Associate Professor, Department of Dermatology, Howard University Hospital

David Green, MD, PA is a member of the following medical societies: American Academy of Dermatology, American Academy of Facial Plastic and Reconstructive Surgery, American College of Phlebology, American Medical Association, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory J Raugi, MD, PhD  Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD  Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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