Spider angioma (spider nevus/ spider veins/ nevus araneus/ vascular spider) is a collection of small, dilated blood vessels, which are clustered and present very close to the skin's surface. This group of vessels is similar to a spider web and has a central spot with vessels radiating from it; thus the name given, spider angioma.
The potential causes of spider angioma are many, including sun exposure, injuries, hormonal changes, or medical conditions, such as liver disease. But in most cases the cause of spider angioma is not known. In many patients, spider angioma is not a cause of medical concern, but in some patients there may be discomfort because of this. These clusters vessels can be removed or treated in various ways, such as by using compression stockings, giving chemical injections and treating with lasers.
Pathophysiology of Spider Angioma
There are six categories of vascular malformations: malformations, hamartomas, hyperplasias, dilatation of preexisting vessels, malignant and benign neoplasms. Spider angiomas occur as a result of the dilation of the preexisting vessels and are not vascular proliferations. Most of the lesions are not associated to any internal disease, but in some cases, spider angiomas have been found related with thyrotoxicosis and are often found in conditions where there is excessive estrogen present, such as in pregnancy or when using oral contraceptives. These lesions resolve about six to nine months postpartum or after the oral contraceptives are discontinued.
Spider angiomas can also be seen in liver disease, liver failure and cirrhosis. Spider angiomas when present with liver disease are numerous and large in size. They also tend to appear in atypical locations. Other than spider angiomas, other findings may also be present, such as palmar erythema, gynecomastia, muscle atrophy, jaundice, ascites, splenomegaly, onychomycosis, leukonychia and longitudinal striations on the nails. The amount of lesions present can be an indication of the extent of hepatic fibrosis.
Signs & Symptoms of Spider Angioma
In majority of the patients, the only symptom of spider angioma is the appearance of the cluster of the vessels. A red dot may be present in the center of the cluster of thin vessels. These thin vessels are shaped like a spider's web and can be of blue, red or purple color. Application of pressure on these cluster will make them disappear and; but they will reappear as soon as the pressure is removed and the blood starts to flow back into the vessels. Spider angioma is commonly seen on the face, neck, and legs but can occur anywhere on the body. There are some patients who will have aching or burning in the region of the spider angioma. This pain is experienced when the spider angioma is present on the legs, and after long periods of standing.
If the patient does not have any other symptoms or health problems, then spider angioma is quite harmless. However, if the patient has other symptoms with spider angioma, such as feeling weak, tired, bloated, yellowish appearance of the skin or eyes, then it is important to seek medical consultation as soon as possible. If the patient has multiple clusters of spider angioma, then also it is important to seek medical consultation, as it could be an indication of underlying liver problem.
Causes of Spider Angioma
The cause of spider angioma is not clear. According to research, there are some factors which can result in spider angioma including sun exposure, injury, hormone level fluctuations, and any underlying medical problems, such as liver disease. If there are multiple spider angiomas, then it is a common indication of liver disease. Patients having liver disease commonly have five or more than five clusters of vessels or arterioles at a time. A lot of estrogen in the body commonly results in formation of spider angioma. This can be seen in conditions, such as chronic liver disease and pregnancy. Spider angioma is more common in patients who are suffering from liver cirrhosis, which is alcohol-related when compared to patients who have non-alcohol related cirrhosis.
Risk Factors for Spider Angioma
Even though the exact cause of spider angioma is not completely understood, there are several risk factors for this condition, such as:
- Age: As a person ages, the risk of getting spider angioma is also increased. This could be because the aging causes weakening of the valves in the blood vessels.
- Sun exposure, especially for people who are fair-skinned, increases the risk of formation of spider angioma on the face.
- Hormonal changes, such as occurring during puberty, pregnancy, and menopause and also when taking oral hormonal contraceptives can lead to spider angioma.
- Family history of weak vessel valves increases the risk of having the same, leading to spider angioma.
- Obesity increases the risk of spider angioma as the excessive weight puts increased pressure on the blood vessels leading to spider angioma.
- Standing or sitting for prolonged periods of time or staying immobile hinders healthy circulation of blood leading to formation of clusters of blood vessels, which is known as spider angioma.
Investigations to Diagnose Spider Angioma
The diagnosis of spider angioma can simply be made by looking at the appearance of the skin. However, it is also important to diagnose the underlying cause of spider angioma and rule out certain serious medical conditions, which have led to formation of these clusters of vessels. The doctor will ask questions regarding hormone supplements or other medications which you are taking. The doctor will also ask about alcohol consumption as excessive alcohol use can cause liver disease and spider angioma can be a sign of liver disease. In case any liver problems are suspected, then blood tests are done to confirm the diagnosis. There is a test for liver diseases known as liver panel, which can be done to test for proteins and enzymes which are produced and excreted by the liver. If the levels are increased or decreased, then it indicates liver disease.
Treatment for Spider Angioma
In majority of the cases, treatment is not required for spider angioma, especially if the patient is not having any associated symptoms with it. If the spider angioma is not causing any discomfort, itching or burning, then they are not harmful. If they are causing all the above problems or are present in multiple clusters, then treatment should be sought by diagnosing and treating the underlying cause first. Treatment can also be done if the spider angioma is causing embarrassment to the patient and he/she wants them removed for cosmetic purposes. Laser Treatment is one such treatment which works on the spider angioma by causing it to gradually fade and disappear. The laser treatment can emit some heat, which causes pain and discomfort for the patient, but this, however, goes away after the laser is removed. Two to five treatment sittings of laser are needed to completely fade the spider angioma.
Prevention of Spider Angioma
It may not be possible to completely prevent spider angioma. If the patient is predisposed to this condition through genes and family history, then the patient is at an increased risk for spider angioma no matter what he/she does to prevent it. There are some measures, which can be undertaken for preventing formation of new spider angioma such as:
- Sunscreen should always be worn when stepping out into the sun, especially on the most commonly affected areas such as face, neck and legs.
- Consumption of alcohol should be avoided.
- Hormone therapy should be avoided.
- Treatment should be done of any underlying liver disease.