Telangiectasia – Causes, Symptoms and Treatment
Telangiectasia refers to permanently dilated small blood vessels visible through the skin as red or purple thread-like lines. They are often harmless but can indicate underlying medical conditions.
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Telangiectasia refers to permanently dilated small blood vessels visible through the skin as red or purple thread-like lines. They are often harmless but can indicate underlying medical conditions.
What is Telangiectasia?
Telangiectasia (plural: telangiectasias or telangiectases) describes the permanent dilation of small blood vessels – including capillaries, arterioles, and venules – that become visible just beneath the surface of the skin or on mucous membranes. They appear as fine red, purple, or blue thread-like or spider-shaped lines and typically measure between 0.1 and 1 millimetre in diameter. On the legs, they are commonly referred to as spider veins.
Causes
Telangiectasias can arise from a variety of causes and are classified as either primary (occurring independently) or secondary (resulting from an underlying condition):
- Genetic predisposition: A family history is frequently observed.
- Hormonal factors: Pregnancy, oestrogen-containing medications, or hormonal contraceptives can promote vessel dilation.
- Chronic UV exposure: Long-term sun damage weakens vessel walls and promotes the development of telangiectasias.
- Rosacea: A chronic inflammatory skin condition of the face that is commonly associated with telangiectasias.
- Chronic venous insufficiency: Weakened venous valves and elevated venous pressure, particularly in the legs.
- Hereditary haemorrhagic telangiectasia (HHT, also known as Osler-Weber-Rendu syndrome): A rare inherited disorder causing telangiectasias on the skin, mucous membranes, and internal organs.
- Scleroderma and other connective tissue disorders: Autoimmune diseases affecting the vascular system.
- Liver disease: Conditions such as liver cirrhosis can lead to spider naevi – star-shaped telangiectasias on the skin.
- Radiation therapy: Localised telangiectasias may develop as a late side effect of radiotherapy.
Symptoms
Telangiectasias are generally not painful or physically harmful. Common findings and accompanying symptoms include:
- Visible red, blue, or purple fine vessels, most commonly on the face (cheeks, nose, chin) or legs
- Occasional burning, itching, or mild tightness in the affected area
- Recurrent bleeding from telangiectasias on mucous membranes (e.g. nose, gastrointestinal tract), as seen in hereditary haemorrhagic telangiectasia
- Cosmetic concern and visible changes to skin appearance
Diagnosis
Diagnosis is typically made through clinical examination of the skin. Additional investigations may include:
- Dermoscopy: A magnified examination of skin lesions using a dermatoscope to assess vessel structure.
- Duplex ultrasonography: Ultrasound imaging of the veins, particularly when chronic venous insufficiency is suspected as the underlying cause.
- Blood tests and further diagnostics: When systemic causes such as liver disease, autoimmune conditions, or hereditary haemorrhagic telangiectasia are suspected.
- Genetic testing: Recommended when hereditary haemorrhagic telangiectasia is suspected based on family history or clinical presentation.
Treatment
The need for treatment depends on the extent, underlying cause, and the degree to which the condition affects the patient. Available treatment options include:
Laser Therapy
The Nd:YAG laser and the pulsed dye laser (PDL) are highly effective for selectively destroying dilated vessels. The light energy is absorbed by haemoglobin in the blood, causing the vessel to heat up and collapse without significantly damaging the surrounding tissue.
Sclerotherapy
Particularly effective for telangiectasias of the legs, sclerotherapy involves injecting a sclerosing agent (e.g. polidocanol) directly into the affected vessel. This causes inflammation of the vessel wall and leads to its permanent closure.
Intense Pulsed Light (IPL)
Broad-spectrum light is used to treat diffuse redness and facial telangiectasias, especially in patients with rosacea.
Treatment of the Underlying Condition
For secondary telangiectasias, treating the root cause is the primary focus. In hereditary haemorrhagic telangiectasia, options such as bevacizumab or endoscopic procedures may be used for bleeding control.
Prevention and General Measures
- Consistent use of sun protection (SPF 30 or higher)
- Avoiding extreme heat sources such as saunas and very hot water
- Compression stockings for venous insufficiency
- Regular exercise and weight management to reduce pressure on leg veins
References
- Rabe E. et al.: European guidelines for sclerotherapy in chronic venous disorders. Phlebology, 2014; 29(6):338-354.
- Faughnan M.E. et al.: International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. Journal of Medical Genetics, 2011; 48(2):73-87.
- Bolognia J.L., Jorizzo J.L., Schaffer J.V.: Dermatology, 3rd edition. Elsevier Saunders, 2012.
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