Nevus Araneus (Spider Nevus) 

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

Background

Nevus araneus, also known as spider angioma or spider nevus, is a common benign vascular lesion present in 10-15% of healthy adults and young children.[1, 2] They may appear as a solitary or multiple lesions.[2] In particular, when multiple lesions are present, liver disease, estrogen therapy, and thyrotoxicosis are worth considering. The name stems from its physical appearance, which is characterized by a central red arteriole, or punctum, representing the body of the spider, surrounded by a radial pattern of thin-walled capillaries, resembling legs (see the image below).

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.

Nevus araneus lesions range in size from 1-10 mm in diameter. Compression of the central vessel with a slide (diascopy) results in blanching and temporary obliteration of the lesion, which is followed by rapid return of blood flow upon release.[1] Pulsations may occasionally be felt upon compression of the punctum.[3] In adults, spider angiomas (nevus araneus) are most frequently found on exposed areas of the body, such as the face, neck, upper trunk (above the nipple line), and arms. In children, the backs of the hands and fingers are commonly affected.[1, 3]

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Pathophysiology

Vascular malformations can be classified into 6 categories: hamartomas, malformations, dilatations of preexisting vessels, hyperplasias, benign neoplasms, and malignant neoplasms.[3] Spider angiomas (nevus araneus) are not vascular proliferations; they occur as a result of the dilation of preexisting vessels.[1, 3]

While most lesions are unrelated to internal disease, spider angiomas (nevus araneus) have been associated with thyrotoxicosis,[4] and frequently occur in the presence of estrogen-excess states, such as pregnancy or during the use of oral contraceptives. Resolution of lesions in this context is common 6-9 months postpartum or after discontinuation of oral contraceptive medication.[5]

Spider angiomas (nevus araneus) are also associated with liver disease, liver failure, and cirrhosis.[6, 7, 8] In fact, the spider angioma is rumored to have received its name from barmaids in New York, who used the lesion as a marker of liver disease in customers.[4] When associated with liver disease, spider angiomas may be numerous, and other findings may be present, including palmar erythema, muscle atrophy, gynecomastia, ascites, jaundice, splenomegaly,[4] as well as nail findings such as leukonychia, onychomycosis, and longitudinal striations.[9] The number of lesions may be indicative of the extent of hepatic fibrosis.[8]

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Epidemiology

Frequency

United States

Young children and pregnant women most frequently exhibit spider angioma (nevus araneus) lesions. In pregnant women, palmar erythema may also be present.[5] Spider angiomas are common in otherwise healthy children and are present in 10-15% of healthy adults and young children.[1]

International

The frequency of spider angiomas (nevus araneus) is presumed to be similar to that in the United States.

Mortality/Morbidity

Spider angiomas (nevus araneus) are asymptomatic benign lesions. When extensive, they may be associated with significant underlying internal pathology, such as liver disease.[6, 7, 8] Spider angiomas (nevus araneus) also may produce significant cosmetic concerns in some patients.

Although a finding of 5 or more spider nevi is common in children with liver disease, this quantity can also be present in many healthy children.[2]

Race

No racial predilection is reported for spider angioma (nevus araneus), but lesions are more apparent in light-skinned patients.

Sex

Spider angiomas (nevus araneus) are more common in women than in men, although a definitive study documenting this is not available. Young children of both sexes and pregnant women frequently exhibit lesions.[2, 5]

Age

One study demonstrated that 38% percent of healthy, school-aged children (ages 5-15 y) had at least one spider nevus (nevus araneus), while most had 1-4 lesions. The trend was an increasing number of lesions with increasing age.[2] Spider angiomas also are common in women of childbearing age in association with pregnancy or oral contraceptive use.[5]

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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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  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].

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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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