Nevus Araneus (Spider Nevus) Clinical Presentation
- Author: Sarah Sweeney Pinney, MD; Chief Editor: Dirk M Elston, MD more...
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.
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.
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.
Examine the patient for signs of pregnancy, including abdominal enlargement, weight gain, palmar erythema, and/or edema.
Patients with significant internal disease may exhibit numerous prominent lesions over the trunk and face, as shown in the image below.
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]
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. Additionally, other biologic substances, including vascular endothelial growth factor (VEGF), basic fibroblastic growth factor (bFGF), substance P, and endogenous vasodilators, 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.
In the context of liver disease, spider nevi are found more commonly in alcoholic cirrhotics versus nonalcoholic cirrhotics, as well as disease secondary to alcohol abuse versus that caused by viral hepatitis.
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.
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