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Generalized Essential Telangiectasia Treatment & Management

  • Author: David Green, MD, PA; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Oct 09, 2015
 

Medical Care

Capillary telangiectases (red telangiectases, usually < 0.2 mm in diameter) in generalized essential telangiectasia, as with randomly occurring capillary telangiectases of the lower extremity, are relatively refractory to treatment. No consistently effective treatment can remove the capillary telangiectases of generalized essential telangiectasia, although case reports describe success using photothermal coagulation with laser and intense pulsed light (IPL).[14]

Capillary telangiectases should be distinguished from venous telangiectases (blue telangiectases, usually >0.2 mm in diameter). While venous telangiectases are quite responsive to sclerotherapy, capillary telangiectases are usually resistant to sclerotherapy.[15] In fact, attempting sclerotherapy to remove capillary telangiectases carries a high risk of local development of new capillary telangiectases. These new capillaries often appear as pink or red patches because the capillaries are so numerous. These patches of capillary telangiectases—a well-recognized effect of sclerotherapy—are known as telangiectatic capillary mattes, and this adverse effect of treatment is known as telangiectatic capillary matting.

In one case report, a 39-year-old woman with a 7-year history of progressive generalized essential telangiectasia who was treated empirically using tetracycline noted a decrease in the telangiectases within 3 weeks of beginning oral tetracycline, with complete resolution within 3 months.[16] Treatment using tetracycline had been initiated empirically in this patient because of the vascular resemblance to tetracycline-responsive rosacea. The mechanism of action of the amelioration remains obscure.

In another report, a patient with widespread telangiectases along with autoimmune thyroiditis, progressive muscle weakness, and small varicose veins of the legs had complete clearing of the telangiectases after treatment using oral acyclovir.[17] Involution was noted within 3 weeks, with almost complete clearance at 2 months. Treatment was continued for 5 months without recurrence. Acyclovir had no effect on the larger ectatic veins, muscle weakness, or thyroiditis. Acyclovir was initiated because of the possibility that a viral infection may have been the underlying cause of an autoimmune syndrome.

Another report noted the disappearance of generalized telangiectases with ketoconazole[18] ; however, in most patients affected by generalized essential telangiectasia, no improvement occurs using these or other medications.

Cover-up cosmetic makeup and self-tanning lotion can be used to conceal telangiectases. Makeup provides some relief to patients who are self-conscious about their appearance.

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Surgical Care

Treatment can be attempted with a laser that specifically targets vascular lesions, including long-pulse Nd:YAG (532 nm), long-pulse frequency-doubled Nd:YAG (1064 nm), or flashlamp-pumped pulsed dye laser (585 nm).[19, 20] However, capillary telangiectases of the lower extremity, unlike those on the face, are not as responsive to photothermal coagulation with currently available vascular lasers. Multiple treatments are usually required, and, often, many of the treated capillaries remain.

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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 College of Phlebology, American Medical Association, American Society for Laser Medicine and Surgery, American Academy of Facial Plastic and Reconstructive Surgery, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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.

References
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  3. Ali MM, Teimory M, Sarhan M. Generalized essential telangiectasia with conjunctival involvement. Clin Exp Dermatol. 2006 Nov. 31(6):781-2. [Medline].

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  9. Sadick NS, Niedt GW. A study of estrogen and progesterone receptors in spider telangiectasias of the lower extremities. J Dermatol Surg Oncol. 1990 Jul. 16(7):620-3. [Medline].

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  13. Braverman IM. Ultrastructure and organization of the cutaneous microvasculature in normal and pathologic states. J Invest Dermatol. 1989 Aug. 93(2 Suppl):2S-9S. [Medline].

  14. Wenzel SM, Hohenleutner U, Landthaler M. Progressive disseminated essential telangiectasia and erythrosis interfollicularis colli as examples for successful treatment with a high-intensity flashlamp. Dermatology. 2008. 217(3):286-90. [Medline].

  15. Green D. Sclerotherapy treatment insights. Dermatol Clin. 1998 Jan. 16(1):195-211. [Medline].

  16. Shelley WB. Essential progressive telangiectasia. Successful treatment with tetracycline. JAMA. 1971 May 24. 216(8):1343-4. [Medline].

  17. Shelley WB, Shelley ED. Essential progressive telangiectasia in an autoimmune setting: successful treatment with acyclovir. J Am Acad Dermatol. 1989 Nov. 21(5 Pt 2):1094-6. [Medline].

  18. Shelley WB, Fierer JA. Focal intravascular coagulation in progressive ascending telangiectasia: ultrastructural studies of ketoconazole-induced involution of vessels. J Am Acad Dermatol. 1984 May. 10(5 Pt 2):876-87. [Medline].

  19. Buscaglia DA, Conte ET. Successful treatment of generalized essential telangiectasia with the 585-nm flashlamp-pumped pulsed dye laser. Cutis. 2001 Feb. 67(2):107-8. [Medline].

  20. Gambichler T, Avermaete A, Wilmert M, Altmeyer P, Hoffmann K. Generalized essential telangiectasia successfully treated with high-energy, long-pulse, frequency-doubled Nd:YAG laser. Dermatol Surg. 2001 Apr. 27(4):355-7. [Medline].

  21. Blume JE. Generalized essential telangiectasia: a case report and review of the literature. Cutis. 2005 Apr. 75(4):223-4. [Medline].

 
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