Nevus Araneus (Spider Nevus) Clinical Presentation

  • Author: Ronald P Rapini, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Oct 20, 2010
 

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 refiThe spider angioma has been compressed and is refilling rapidly from the central vessel. A spider nevus consists of a central arteriole witA 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 other signs of pregnancy, such as 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 cirrhosMultiple 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, 9]

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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.[10] More recently, other biologic substances, including vascular endothelial growth factor (VEGF),[11] basic fibroblastic growth factor (bFGF),[12] substance P, and endogenous vasodilators,[10] 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.[10]

In the context of liver disease, spider nevi are found more commonly in alcoholic cirrhotics versus nonalcoholic cirrhotics,[13] as well as disease secondary to alcohol abuse versus that caused by viral hepatitis.[14]

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

Ronald P Rapini, MD  Josey Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School at Houston and MD Anderson Cancer Center

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

Disclosure: Elsevier publishers Royalty Independent contractor

Coauthor(s)

Sarah A Sweeney  University of Texas Medical School at Houston

Sarah A Sweeney is a member of the following medical societies: Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

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

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn 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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

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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  2. Finn SM, Rowland M, Lawlor F, Kinsella W, Chan L, Byrne O, et al. The significance of cutaneous spider naevi in children. Arch Dis Child. Jul 2006;91(7):604-5. [Medline]. [Full Text].

  3. Requena L, Sangueza OP. Cutaneous vascular anomalies. Part I. Hamartomas, malformations, and dilation of preexisting vessels. J Am Acad Dermatol. Oct 1997;37(4):523-49; quiz 549-52. [Medline]. [Full Text].

  4. Graham-Brown RA. Hepatobiliary System and the Skin. In: Irwin Freedberg AE, Klaus Wolff, K Frank Austen, Lowell Goldsmith, Stephen Katz, Thomas Fitzpatric. Fitzpatrick's Dermatology In General Medicine. Fifth. New York: McGraw-Hill; 1999:1918.

  5. Henry F, Quatresooz P, Valverde-Lopez JC, Piérard GE. Blood vessel changes during pregnancy: a review. Am J Clin Dermatol. 2006;7(1):65-9. [Medline]. [Full Text].

  6. Detry O, De Roover A. Images in clinical medicine. Spider angiomas. N Engl J Med. Jan 15 2009;360(3):280. [Medline]. [Full Text].

  7. Akiyama M, Inamoto N. Arteriovenous haemangioma in chronic liver disease: clinical and histopathological features of four cases. Br J Dermatol. Mar 2001;144(3):604-9. [Medline]. [Full Text].

  8. Niederau C, Lange S, Frühauf M, Thiel A. Cutaneous signs of liver disease: value for prognosis of severe fibrosis and cirrhosis. Liver Int. May 2008;28(5):659-66. [Medline]. [Full Text].

  9. Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol. Jun 2010;24(6):649-54. [Medline]. [Full Text].

  10. Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, et al. Role of substance P in the pathogenesis of spider angiomas in patients with nonalcoholic liver cirrhosis. Am J Gastroenterol. Feb 1999;94(2):502-7. [Medline]. [Full Text].

  11. Isner JM, Pieczek A, Schainfeld R, Blair R, Haley L, Asahara T, et al. Clinical evidence of angiogenesis after arterial gene transfer of phVEGF165 in patient with ischaemic limb. Lancet. Aug 10 1996;348(9024):370-4. [Medline]. [Full Text].

  12. Li CP, Lee FY, Hwang SJ, Lu RH, Lee WP, Chao Y, et al. Spider angiomas in patients with liver cirrhosis: role of vascular endothelial growth factor and basic fibroblast growth factor. World J Gastroenterol. Dec 2003;9(12):2832-5. [Medline]. [Full Text].

  13. Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, et al. Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function. Scand J Gastroenterol. May 1999;34(5):520-3. [Medline]. [Full Text].

  14. Iino S. [Differentiation alcoholic liver cirrhosis from viral liver cirrhosis]. Nippon Rinsho. Jan 1994;52(1):174-80. [Medline].

  15. Collyer J, Boone SL, White LE, Rademaker A, West DP, Anderson K. Comparison of treatment of cherry angiomata with pulsed-dye laser, potassium titanyl phosphate laser, and electrodesiccation: a randomized controlled trial. Arch Dermatol. Jan 2010;146(1):33-7. [Medline]. [Full Text].

  16. Sivarajan V, Al Aissami M, Maclaren W, Mackay IR. Recurrence of spider naevi following treatment with 585 nm pulsed dye laser. J Plast Reconstr Aesthet Surg. 2007;60(6):668-71. [Medline]. [Full Text].

  17. Clark C, Cameron H, Moseley H, Ferguson J, Ibbotson SH. Treatment of superficial cutaneous vascular lesions: experience with the KTP 532 nm laser. Lasers Med Sci. 2004;19(1):1-5. [Medline]. [Full Text].

  18. Bjerring P, Christiansen K, Troilius A. Intense pulsed light source for treatment of facial telangiectasias. J Cosmet Laser Ther. Dec 2001;3(4):169-73. [Medline]. [Full Text].

  19. Kono T, Sakurai H, Groff WF, Chan HH, Takeuchi M, Yamaki T, et al. Comparison study of a traditional pulsed dye laser versus a long-pulsed dye laser in the treatment of early childhood hemangiomas. Lasers Surg Med. Feb 2006;38(2):112-5. [Medline]. [Full Text].

  20. Michel JL. Treatment of hemangiomas with 595 nm pulsed dye laser dermobeam. Eur J Dermatol. Mar-Apr 2003;13(2):136-41. [Medline].

  21. Tan E, Vinciullo C. Pulsed dye laser treatment of spider telangiectasia. Australas J Dermatol. Feb 1997;38(1):22-5. [Medline]. [Full Text].

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  23. Woo SH, Ahn HH, Kim SN, Kye YC. Treatment of vascular skin lesions with the variable-pulse 595 nm pulsed dye laser. Dermatol Surg. Jan 2006;32(1):41-8. [Medline]. [Full Text].

 
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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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