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Nevus Araneus (Spider Nevus) Clinical Presentation

  • Author: Sarah Sweeney Pinney, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 16, 2016
 

History

Spider angioma (nevus araneus) is asymptomatic and acquired. The following inquiries may be helpful:

  • 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.
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Physical

Spider angiomas (nevi araneus) are red with a small central arteriole, or punctum, surrounded by thin-walled vessels radiating in a stellate pattern.[1, 3] Sometimes, the punctum is the main finding, without the "legs" of the spider. The lesion measures 1-10 mm in diameter.[1]

Application of pressure to the lesion with a slide (diascopy) causes blanching and temporary obliteration. This is followed by rapid refilling from the central arteriole upon release of pressure. Occasionally, pulsation of the punctum is noted.[1, 3]

Lesions most commonly occur in exposed areas of the skin, including the face, neck, upper trunk, and arms in adults. In children, lesions are common on the fingers and hands.[1, 3] Note the images below.

Large spider angioma on the left cheek of a child. Large spider angioma on the left cheek of a child.
The spider angioma has been compressed and is refi The spider angioma has been compressed and is refilling rapidly from the central vessel.
A spider nevus consists of a central arteriole wit 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.

Examine the patient for signs of pregnancy, including abdominal enlargement, weight gain, palmar erythema, and/or edema.[5]

Patients with significant internal disease may exhibit numerous prominent lesions over the trunk and face, as shown in the image below.[1]

Multiple spider angiomas in a patient with cirrhos Multiple spider angiomas in a patient with cirrhosis.

Perform a comprehensive abdominal examination with special attention to the liver and spleen. Examine patients for stigmata of liver disease, including ascites, palmar erythema, changes in body fat and hair distribution, muscle and gonadal atrophy, splenomegaly, and leukonychia.[1, 4, 11]

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Causes

The exact etiology of the spider nevus (nevus araneus) is unclear. Estrogen-excess states such as pregnancy and liver disease have been associated with spider angiomas for many years. This hypothesis is partially based on the hormone’s dilating effects on endometrial spiral arterioles during pregnancy.[12] Additionally, other biologic substances, including vascular endothelial growth factor (VEGF),[13] basic fibroblastic growth factor (bFGF),[14] substance P, and endogenous vasodilators,[12] have been implicated in the pathogenesis of spider angioma (nevus araneus). One study demonstrated that although the ratio of estrogen to testosterone in the serum of cirrhotic patients did, in fact, vary inversely with liver function, the numbers never reached statistical significance.[12]

In the context of liver disease, spider nevi are found more commonly in alcoholic cirrhotics versus nonalcoholic cirrhotics,[15] as well as disease secondary to alcohol abuse versus that caused by viral hepatitis.[16]

Children with liver disease rarely have large numbers of spider angiomas. Although the finding of 5 or more spider angiomas is more common in persons with liver disease, many healthy children also have one or more of these lesions.[2]

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Contributor Information and Disclosures
Author

Sarah Sweeney Pinney, MD Assistant Professor, Department of Dermatology, University of Texas Medical School at Houston

Sarah Sweeney Pinney, MD is a member of the following medical societies: American Academy of Dermatology, Texas Dermatological Society, Texas Medical Association, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, Texas Medical Association

Disclosure: Received royalty from Elsevier publishers for independent contractor; May receive consulting fee from FDA panel for consulting in future, since I am on one of their committees, but at this time so far have received zero from FDA.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

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

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Mark Crowe, MD, to the development and writing of this article.

References
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Large spider angioma on the left cheek of a child.
The spider angioma has been compressed and is refilling rapidly from the central vessel.
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.
Multiple spider angiomas in a patient with cirrhosis.
 
 
 
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