Nevus Araneus (Spider Nevus) Treatment & Management
- Author: Sarah Sweeney Pinney, MD; Chief Editor: Dirk M Elston, MD more...
In children, treatment usually is not necessary, and while some lesions resolve spontaneously, others may be permanent. 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.
Numerous lesions associated with liver disease may improve upon treatment of the underlying condition. Reports have described regression after liver transplantation.
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 intervention. 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. 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.[18, 19, 20, 21, 22, 23, 24, 25] 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. 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 cleared or markedly improved 99% of 128 patients with spider angiomas, as well as other superficial vascular lesions, with only minimal adverse effects.
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.
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