Nevus Araneus (Spider Nevus) Clinical Presentation

Updated: May 11, 2018
  • Author: Sarah Sweeney Pinney, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
  • Print
Presentation

History

Spider angioma (nevus araneus) is asymptomatic and acquired. The following inquiries may be helpful:

  • Ask female patients if they are pregnant, using hormonal supplements, or taking oral contraceptives.

  • Inquire about patient history of alcohol abuse.

  • Ask patients if they are taking medications that may result in liver damage.

Next:

Physical Examination

Spider angiomas (nevi araneus) are red with a small central arteriole, or punctum, surrounded by thin-walled vessels radiating in a stellate pattern. [1, 3] Sometimes, the punctum is the main finding, without the "legs" of the spider. The lesion measures 1-10 mm in diameter. [1]

Application of pressure to the lesion with a slide (diascopy) causes blanching and temporary obliteration. This is followed by rapid refilling from the central arteriole upon release of pressure. Occasionally, pulsation of the punctum is noted. [1, 3]

Lesions most commonly occur in exposed areas of the skin, including the face, neck, upper trunk, and arms in adults. In children, lesions are common on the fingers and hands. [1, 3] Note the images below.

Large spider angioma on the left cheek of a child. Large spider angioma on the left cheek of a child.
The spider angioma has been compressed and is refi The spider angioma has been compressed and is refilling rapidly from the central vessel.
A spider nevus consists of a central arteriole wit 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.

Examine the patient for signs of pregnancy, including abdominal enlargement, weight gain, palmar erythema, and/or edema. [5]

Patients with significant internal disease may exhibit numerous prominent lesions over the trunk and face, as shown in the image below. [1]

Multiple spider angiomas in a patient with cirrhos Multiple spider angiomas in a patient with cirrhosis.

Perform a comprehensive abdominal examination with special attention to the liver and spleen. Examine patients for stigmata of liver disease, including ascites, palmar erythema, changes in body fat and hair distribution, muscle and gonadal atrophy, splenomegaly, and leukonychia. [1, 4, 11]

Previous
Next:

Complications

No significant complications are associated with spider angioma (nevus araneus); however, cosmetic issues may be of significant concern to some patients or to parents.

Previous