Nevus Araneus (Spider Nevus) Treatment & Management

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

Medical Care

In children, treatment usually is not necessary, and while some lesions resolve spontaneously, others may be permanent.[1] Spider angiomas (nevi araneus) that regress do so over the course of several years.

In young women, lesions often resolve spontaneously within 6 weeks to 9 months after the birth of a child or after discontinuing oral contraceptives.[5]

Numerous lesions associated with liver disease may improve upon treatment of the underlying condition. Reports have described regression after liver transplantation.[6]

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Surgical Care

Electrodesiccation and laser treatment both can be effective for bothersome facial spider angiomas. Although the risk of a small scar may be slightly higher with electrodesiccation, good results generally are achieved with either electrodesiccation or laser treatment. Although cherry angiomas are different vascular lesions, a rater-blinded randomized controlled study of treatment of those showed very little difference between the results of electrodesiccation versus the pulsed dye or KTP laser.[15] Usually, disappearance of the spider angioma follows electrodesiccation. Recurrences are common.

To perform electrodesiccation, move the blood out of the spider by pressing firmly on the lesion. With continuous pressure, slightly move the finger to one side to expose the central arteriole. Then, gently electrodesiccate the central arteriole. If the arteriole is destroyed, radiating capillaries may not fill. Incompletely destroyed lesions may recur. Vigorous desiccation may cause a pitted scar.

Currently available laser systems may eliminate the lesion completely or achieve only partial clearing.[16, 17, 18, 19, 20, 21, 22, 23] In one study, the rate of initial clearing with the 585-nm pulsed dye laser was 95%. The mean follow-up was 37.9 months. Of the 73% of patients who responded to the follow-up survey, 50 (36%) had experienced recurrence of the lesion.[16] Recurrence appears to be related to the deeper arteriolar component of the lesion, which remains patent. Another study demonstrated that the KTP 532-nm laser markedly improved or cleared 57 (98%) of 58 of patients with spider angiomas, as well as other vascular lesions, at the end of a 2-year period.[17]

Local anesthesia prior to therapy is optional in adults but advisable in children. Intradermal injection of 0.1-0.2 mL physiological saline solution produces brief complete anesthesia of the site and does not sting on injection. This represents a viable alternative to lidocaine. The central vascular papule has very few nerve endings. Rather than intradermal anesthesia injection, a 30-gauge needle can be inserted directly into the central papule. Anesthesia is flushed into the spider angioma, producing less pain.

See Laser Treatment of Acquired and Congenital Vascular Lesions and Laser Treatment of Benign Pigmented Lesions.

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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].

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  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].

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  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].

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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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