eMedicine Specialties > Dermatology > Diseases of the Vessels
Nevus Araneus (Spider Nevus)
Updated: May 29, 2009
Introduction
Background
Spider angiomas are common, benign, acquired lesions present in 10-15% of healthy adults and young children. One lesion, or occasionally, a small number of lesions, develops in children or adults. Lesions are found most commonly on the face, neck, upper part of the trunk, and arms. In young children, spider angiomas are common on the backs of the hands and fingers.
Most lesions are unrelated to internal disease. Many women develop lesions during pregnancy or while taking oral contraceptives. These lesions are asymptomatic and usually resolve spontaneously 6-9 months after delivery or after discontinuing oral contraceptives. Numerous prominent spider angiomas are observed in patients with significant hepatic disease.
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.
Pathophysiology
Cutaneous vascular anomalies may be classified into the following categories: hamartomas, malformations, dilatations of preexisting vessels, hyperplasias, benign neoplasms, and malignant neoplasms. Spider angiomas are not vascular proliferations but occur as a result of the dilation of preexisting vessels.
Frequency
United States
Young children and pregnant women most frequently exhibit lesions. In pregnant women, palmar erythema usually is present. Spider angiomas are common in otherwise healthy children and are present in 10-15% of healthy adults and young children.
International
Frequency is presumed to be similar to that in the United States.
Mortality/Morbidity
Spider angiomas are asymptomatic benign lesions. When extensive, they may be associated with significant underlying internal pathology. Spider angiomas also may produce significant cosmetic concerns in some patients.
Race
No racial predilection is reported, but lesions are more apparent in light-skinned patients.
Sex
Young children of both sexes and pregnant women most frequently exhibit lesions.
Age
Benign solitary spider angiomas most commonly occur in school-aged children.1 Almost one half of children may develop a spider angioma at some point. Spider angiomas also are common in women of childbearing age in association with pregnancy or oral contraceptives.2
Clinical
History
- Lesions are asymptomatic and acquired.
- Rarely, patients report bleeding from a spider angioma following minor trauma.
- 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.
Physical
- Spider angiomas usually are bright red with a small (1 mm), central, red papule surrounded by several distinct radiating vessels. The entire lesion usually is 0.5-1 cm in diameter.3
- Pressure on the lesion causes it to disappear. Blanching is replaced by rapid refill from the central arteriole when pressure is released. Occasionally, pulsation of the central papule is noted.
- Lesions occur most commonly on the face, below the eyes, and over the cheekbones. Other common sites include the hands, forearms, and ears.
Large spider angioma on the left cheek of a child.
The spider angioma has been compressed and is refilling rapidly from the central vessel (same patient as in Media File 1).
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.
- Pregnant women and individuals with liver disease may demonstrate palmar erythema.
- Patients with significant internal disease may exhibit numerous prominent lesions over the trunk and face.
- Examine patients with extensive lesions for palmar erythema, pallid or white nails with distal hyperemic bands, splenomegaly, ascites, jaundice, and asterixis.
Causes
- Rapid development of numerous prominent spider angiomas may occur in patients with hepatic cirrhosis, malignant liver disease, and other hepatic dysfunctions.4,5 A common characteristic is an elevated blood estrogen level.6
- When spider angiomas occur in association with palmar erythema and pallid nails with distal hyperemic bands, consider cirrhosis of the liver. Patients with liver disease may manifest additional symptomatology, including splenomegaly, ascites, jaundice, and asterixis.
- Children with liver disease rarely have large numbers of spider angiomas. Although the finding of 5 or more spider angiomas is more common in liver disease, many normal children also have one or more of these lesions.7
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References
Wenzl JE, Burgert EO Jr. The spider nevus in infancy and childhood. Pediatrics. Feb 1964;33:227-32. [Medline].
Henry F, Quatresooz P, Valverde-Lopez JC, Pierard GE. Blood vessel changes during pregnancy: a review. Am J Clin Dermatol. 2006;7(1):65-9. [Medline].
Detry O, De Roover A. Images in clinical medicine. Spider angiomas. N Engl J Med. Jan 15 2009;360(3):280. [Medline].
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].
McElgunn PS. Dermatologic manifestations of hepatitis B virus infection. J Am Acad Dermatol. Apr 1983;8(4):539-48. [Medline].
Brear SG, Edwards JD, Rademaker M, Doyle L. Hypertrophic osteoarthropathy, spider naevi and oestrogen hyperexcretion associated with adenocarcinoma. Postgrad Med J. Sep 1985;61(719):827-8. [Medline].
Finn SM, Rowland M, Lawlor F, et al. The significance of cutaneous spider naevi in children. Arch Dis Child. Jul 2006;91(7):604-5. [Medline].
Whiting DA, Kallmeyer JC, Simson IW. Widespread arterial spiders in a case of latent hepatitis, with resolution after therapy. Br J Dermatol. Jan 1970;82(1):32-6. [Medline].
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].
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].
Kono T, Sakurai H, Groff WF, 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].
Michel JL. Treatment of hemangiomas with 595 nm pulsed dye laser dermobeam. Eur J Dermatol. Mar-Apr 2003;13(2):136-41. [Medline].
Tan E, Vinciullo C. Pulsed dye laser treatment of spider telangiectasia. Australas J Dermatol. Feb 1997;38(1):22-5. [Medline].
Tan OT, Gilchrest BA. Laser therapy for selected cutaneous vascular lesions in the pediatric population: a review. Pediatrics. Oct 1988;82(4):652-62. [Medline].
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].
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].
Bharath S. Atypical spider nevi distribution in liver disease. Arch Intern Med. Oct 1979;139(10):1193. [Medline].
James WD, Odom RB. Hyperpigmentation occurring in vascular spiders. Arch Dermatol. Aug 1979;115(8):929. [Medline].
Kavak A, Kutluay L. Unilateral nevoid telangiectasia and hyperthyroidism: a new association or coincidence?. J Dermatol. May 2004;31(5):411-4. [Medline].
Li CP, Lee FY, Hwang SJ, 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].
Li CP, Lee FY, Hwang SJ, 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].
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].
Tuppal R, Miller RA, Ing VW, Walsh N. Eruptive spider nevus-like lesions associated with the hyperviscosity syndrome. Arch Dermatol. Jun 1992;128(6):860. [Medline].
Further Reading
Keywords
nevus araneus, spider nevus, spider angioma, spider nevus, vascular spider, spider-like capillary telangiectasis
