Generalized Essential Telangiectasia Treatment & Management

Updated: Dec 15, 2017
  • Author: David Green, MD, PA; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Capillary telangiectases (red telangiectases, usually < 0.2 mm in diameter) in generalized essential telangiectasia, as with randomly occurring capillary telangiectases of the lower extremity, are relatively refractory to treatment. No consistently effective treatment can remove the capillary telangiectases of generalized essential telangiectasia, although case reports describe success using photothermal coagulation with laser and intense pulsed light (IPL). [18]

Capillary telangiectases should be distinguished from venous telangiectases (blue telangiectases, usually >0.2 mm in diameter). While venous telangiectases are quite responsive to sclerotherapy, capillary telangiectases are usually resistant to sclerotherapy. [19] In fact, attempting sclerotherapy to remove capillary telangiectases carries a high risk of local development of new capillary telangiectases. These new capillaries often appear as pink or red patches because the capillaries are so numerous. These patches of capillary telangiectases—a well-recognized effect of sclerotherapy—are known as telangiectatic capillary mattes, and this adverse effect of treatment is known as telangiectatic capillary matting.

In one case report, a 39-year-old woman with a 7-year history of progressive generalized essential telangiectasia who was treated empirically using tetracycline noted a decrease in the telangiectases within 3 weeks of beginning oral tetracycline, with complete resolution within 3 months. [20] Treatment using tetracycline had been initiated empirically in this patient because of the vascular resemblance to tetracycline-responsive rosacea. The mechanism of action of the amelioration remains obscure.

In another report, a patient with widespread telangiectases along with autoimmune thyroiditis, progressive muscle weakness, and small varicose veins of the legs had complete clearing of the telangiectases after treatment using oral acyclovir. [21] Involution was noted within 3 weeks, with almost complete clearance at 2 months. Treatment was continued for 5 months without recurrence. Acyclovir had no effect on the larger ectatic veins, muscle weakness, or thyroiditis. Acyclovir was initiated because of the possibility that a viral infection may have been the underlying cause of an autoimmune syndrome.

Another report noted the disappearance of generalized telangiectases with ketoconazole [22] ; however, in most patients affected by generalized essential telangiectasia, no improvement occurs using these or other medications.

Another report indicated success in treating generalized essential telangiectasia with 6-mercaptopurine, which may indicate the condition represents a state of increased angiogenesis. [23]

Cover-up cosmetic makeup and self-tanning lotion can be used to conceal telangiectases. Makeup provides some relief to patients who are self-conscious about their appearance.

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Surgical Care

Treatment can be attempted with a laser that specifically targets vascular lesions, including long-pulse Nd:YAG (532 nm), long-pulse frequency-doubled Nd:YAG (1064 nm), or flashlamp-pumped pulsed dye laser (585 nm). [24, 25] However, capillary telangiectases of the lower extremity, unlike those on the face, are not as responsive to photothermal coagulation with currently available vascular lasers. Multiple treatments are usually required, and, often, many of the treated capillaries remain.

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