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Nevus Araneus (Spider Nevus) Treatment & Management

  • Author: Sarah Sweeney Pinney, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 16, 2016
 

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 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.[17] 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.[18] 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.[19]

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

Sarah Sweeney Pinney, MD Assistant Professor, Department of Dermatology, University of Texas Medical School at Houston

Sarah Sweeney Pinney, MD is a member of the following medical societies: American Academy of Dermatology, Texas Dermatological Society, Texas Medical Association, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

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

Disclosure: Received royalty from Elsevier publishers for independent contractor; May receive consulting fee from FDA panel for consulting in future, since I am on one of their committees, but at this time so far have received zero from FDA.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

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

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Mark Crowe, MD, to the development and writing of this article.

References
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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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