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Spider Naevus – Causes, Symptoms and Treatment

A spider naevus is a benign skin lesion consisting of a central red spot with fine radiating blood vessels. It often occurs in liver disease or during pregnancy.

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Things worth knowing about "Spider Naevus"

A spider naevus is a benign skin lesion consisting of a central red spot with fine radiating blood vessels. It often occurs in liver disease or during pregnancy.

What Is a Spider Naevus?

A spider naevus (also known as spider angioma, spider telangiectasia, or vascular spider) is a benign skin lesion caused by the dilation of small blood vessels just beneath the skin surface. It consists of a central red arteriole surrounded by fine, radiating capillary branches that resemble the legs of a spider -- hence the name. The lesion typically measures a few millimetres to about one centimetre in diameter.

Causes

Spider naevi develop as a result of localised dilation of small arteries (arterioles) in the skin. While the exact cause is not always clear, the following factors are commonly associated with their appearance:

Liver disease: Chronic liver conditions such as liver cirrhosis or hepatitis are closely linked to the development of spider naevi. A damaged liver cannot adequately metabolise oestrogen, leading to elevated levels that cause vascular dilation.
Pregnancy: Increased oestrogen levels during pregnancy frequently cause temporary spider naevi, which usually resolve after delivery.
Hormonal contraceptives: Oestrogen-containing birth control pills may promote the development of spider naevi.
Idiopathic occurrence: Spider naevi can appear in otherwise healthy individuals, particularly children, without any identifiable cause and often resolve spontaneously.
Chronic alcohol use: Alcohol-related liver damage impairs oestrogen metabolism and significantly increases the risk of developing spider naevi.

Symptoms

A spider naevus is generally asymptomatic and is a purely cosmetic finding. Its characteristics include:

A small, bright red central point (arteriole)
Fine, star-shaped radiating vessel branches
Preferred locations: face, neck, chest, and forearms
Blanching when pressure is applied to the centre, followed by refilling once pressure is released

The presence of more than five spider naevi is considered clinically significant and may indicate underlying liver disease.

Diagnosis

Diagnosis is usually made through a straightforward clinical examination. The characteristic appearance and the blanching-refilling response upon pressure (diascopy) are typically sufficient for identification.

If an underlying condition is suspected, additional investigations may be required:

Blood tests: Liver function tests (AST, ALT, GGT, bilirubin, prothrombin time)
Liver ultrasound
Hormonal analysis if hormonal imbalance is suspected

Treatment

Isolated spider naevi in otherwise healthy individuals generally require no treatment, as they are harmless and often resolve on their own -- for example, after pregnancy or after stopping hormonal contraceptives.

If cosmetic removal is desired, or if treatment is warranted due to an underlying condition, the following options are available:

Laser therapy: Pulsed dye laser (PDL) or other vascular lasers are the preferred treatment, targeting and destroying the dilated vessels with minimal scarring.
Electrocautery: A fine needle delivers an electrical current to obliterate the central feeding vessel.
Sclerotherapy: Injection of a sclerosing agent directly into the vessel.
Treatment of the underlying condition: Addressing the root cause, such as liver disease, may lead to spontaneous regression of spider naevi.

References

Habif, T.P. - Clinical Dermatology: A Color Guide to Diagnosis and Therapy. Elsevier, Philadelphia (6th edition, 2016).
Schiff, E.R. et al. - Schiff's Diseases of the Liver. Wiley-Blackwell, Hoboken (12th edition, 2018).
World Health Organization (WHO) - Chronic liver disease and cirrhosis. Available at: https://www.who.int (accessed 2024).

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