Telangiectasia
Encyclopedia
Telangiectasias /tɛ.læn.dʒiː'ɛk.teɪ.ʃi:ə/ are small dilated blood vessel
s near the surface of the skin or mucous membrane
s, measuring between 0.5 and 1 millimeter in diameter. They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin. They can also develop on the legs, specifically on the upper thigh, below the knee joint, and around the ankles.
Some telangiectasia are due to developmental abnormalities that can closely mimic the behaviour of benign
vascular neoplasm
s. They may be composed of abnormal aggregations of arteriole
s, capillaries, or venule
s. Because telangiectasias are vascular lesions, they blanch
when tested with diascopy
.
These include;
. Flow abnormalities within the medium sized veins of the leg (reticular veins) can also lead to the development of telangiectasia.
Factors that predispose to the development of varicose and telangiectatic leg veins include
is the "gold standard" and is preferred over laser for eliminating telangiectasiae and smaller varicose leg veins. A sclerosant medication is injected into the diseased vein so it hardens and eventually shrinks away. Recent evidence with foam sclerotherapy shows that the foam containing the irritating sclerosant quickly appears in the patients heart and lungs, and then in some cases travels through a patent foramen ovale to the brain. This has led to concerns about the safety of sclerotherapy for telangectasias and spider veins. In some cases stroke
and transient ischemic attacks have occurred after sclerotherapy. Varicose veins
and reticular leg veins, if present, must be treated prior to any treatment of the telangiectasia. Varicose veins can be treated with foam sclerotherapy, endovenous laser treatment
, radiofrequency ablation
or open surgery. The biggest risk, however, seems to occur with sclerotherapy, especially in terms of systemic risk of DVT, pulmonary embolism
, and stroke
.
Another issue that arises with the use of sclerotherapy to treat spider veins is staining, shadowing, telangetatic matting and ulceration. In addition, incompleteness of therapy is common, requiring multiple treatment sessions.
Telangiectasias on the face are often treated with a laser. Laser therapy uses a light beam that is pulsed onto the veins in order to seal them off, causing them to dissolve. These light-based treatments require adequate heating of the veins. These treatments can result in the destruction of sweat glands, the risk increases with the number of treatments.
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
s near the surface of the skin or mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
s, measuring between 0.5 and 1 millimeter in diameter. They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin. They can also develop on the legs, specifically on the upper thigh, below the knee joint, and around the ankles.
Some telangiectasia are due to developmental abnormalities that can closely mimic the behaviour of benign
Benign
A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
vascular neoplasm
Vascular tissue neoplasm
A vascular tissue neoplasm is, as its name would indicate, a vascular tissue tumor.Examples include hemangioma and hemangiopericytoma....
s. They may be composed of abnormal aggregations of arteriole
Arteriole
An arteriole is a small diameter blood vessel in the microcirculation that extends and branches out from an artery and leads to capillaries.Arterioles have muscular walls and are the primary site of vascular resistance...
s, capillaries, or venule
Venule
A venule is a very small blood vessel in the microcirculation that allows deoxygenated blood to return from the capillary beds to the larger blood vessels called veins. Venules range from 8 to 100μm in diameter and are formed when capillaries unite .Venules are blood vessels that drain blood...
s. Because telangiectasias are vascular lesions, they blanch
Blanch (medical)
When skin is blanched, it takes on a whitish appearance as blood flow to the region is prevented. This occurs during and is the basis of the physiologic test known as diascopy....
when tested with diascopy
Diascopy
Diascopy is a test for blanchability performed by applying pressure with a finger or glass slide and observing color changes.It is used to determine whether a lesion is vascular or nonvascular or hemorrhagic . Hemorrhagic lesions and nonvascular lesions do not blanch; inflammatory lesions do...
.
Congenital causes
Goldman states that "numerous inherited or congenital conditions display cutaneous telangiectasia".These include;
- Naevus flammeus (port-wine stain)
- Klippel-Trenaunay syndrome
- Maffucci's syndrome (multiple endochondromas & hemangiomas)
- Hereditary hemorrhagic telangiectasiaHereditary hemorrhagic telangiectasiaHereditary hemorrhagic telangiectasia , also known as Osler-Weber-Rendu disease and Osler-Weber-Rendu syndrome, is a genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs such as the lungs, liver and brain.It may lead to nosebleeds, acute...
(Osler-Weber-Rendu syndrome) - Ataxia-telangiectasia
- Sturge-Weber syndromeSturge-Weber syndromeSturge–Weber syndrome, sometimes referred to as encephalotrigeminal angiomatosis, is a rare congenital neurological and skin disorder. It is one of the phakomatoses and is often associated with port-wine stains of the face, glaucoma, seizures, mental retardation, and ipsilateral leptomeningeal...
, a nevusNevusNevus is the medical term for sharply-circumscribed and chronic lesions of the skin. These lesions are commonly named birthmarks and moles. Nevi are benign by definition...
formation in the skin supplied by the trigeminal nerveTrigeminal nerveThe trigeminal nerve contains both sensory and motor fibres. It is responsible for sensation in the face and certain motor functions such as biting, chewing, and swallowing. Sensory information from the face and body is processed by parallel pathways in the central nervous system...
and associated with facial port-wine stains, glaucomaGlaucomaGlaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...
, meningeal angiomas and mental retardationMental retardationMental retardation is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors...
.
Venous hypertension
Telangiectasia in the legs is often related to the presence of venous hypertension within underlying varicose veinsVaricose veins
Varicose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards . Leg muscles pump the veins to return blood to the heart, against the...
. Flow abnormalities within the medium sized veins of the leg (reticular veins) can also lead to the development of telangiectasia.
Factors that predispose to the development of varicose and telangiectatic leg veins include
- Age: The development of spider veins may occur at any age but usually occurs between 18 and 35 years, and peaks between 50 and 60 years.
- Gender: Females are affected approximately four to one to males.
- Pregnancy: Pregnancy is a key factor contributing to the formation of varicose and spider veins. The most important factor is circulating hormones that weaken vein walls. There's also a significant increase in the blood volume during pregnancy, which tends to distend veins, causing valve dysfunction which leads to blood pooling in the veins. Moreover, later in pregnancy, the enlarged uterus can compress veins, causing higher vein pressure leading to dilated veins. Varicose veins that form during pregnancy may spontaneously improve or even disappear a few months after delivery.
- Lifestyle/Occupation: Those who are involved with prolonged sitting or standing in their daily activities have an increased risk of developing varicose veins. The weight of the blood continuously pressing against the closed valves causes them to fail, leading to vein distention.
Other acquired causes
Acquired telangiectasia, not related to other venous abnormalities, for example on the face and trunk, can be caused by factors such as- Acne rosacea
- Environmental damage such as that caused by sun or cold exposure
- Trauma to skin such as contusions or surgical incisions.
- Radiation exposure such as that experienced during radiotherapy for the treatment of cancer
- Chemotherapy
- Carcinoid syndromeCarcinoid syndromeCarcinoid syndrome refers to the array of symptoms that occur secondary to carcinoid tumors. The syndrome includes flushing and diarrhea, and, less frequently, heart failure and bronchoconstriction...
- CREST syndromeCREST syndromeThe limited cutaneous form of systemic scleroderma is often referred to as CREST syndrome. "CREST" is an acronym for the five main features:* Calcinosis* Raynaud's syndrome* Esophageal dysmotility* Sclerodactyly* Telangiectasia...
(a variant of sclerodermaSclerodermaSystemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
) - Chronic treatment with topicalTopicalIn medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, anus, throat, eyes and ears.Many topical medications are epicutaneous, meaning that they are applied directly to the skin...
corticosteroidCorticosteroidCorticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
s may lead to telangiectasia. - spider angiomas are a radial array of tiny arterioles that commonly occur in pregnant women and in patients with hepatic cirrhosisCirrhosisCirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules , leading to loss of liver function...
and are associated with palmar erythemaPalmar erythemaPalmar erythema is reddening of the palms at the thenar and hypothenar eminences.-Causes:It is associated with various physiological as well as pathological changes, the principal one of which is portal hypertension. It is also seen in patients with liver dysfunction, such as chronic liver disease...
. In men, they are related to high estrogenEstrogenEstrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
levels secondary to liver diseaseLiver diseaseLiver disease is a broad term describing any single number of diseases affecting the liver.-Diseases:* Hepatitis, inflammation of the liver, caused mainly by various viruses but also by some poisons , autoimmunity or hereditary conditions...
.
Treatment
SclerotherapySclerotherapy
Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations and also those of the lymphatic system. A medicine is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations...
is the "gold standard" and is preferred over laser for eliminating telangiectasiae and smaller varicose leg veins. A sclerosant medication is injected into the diseased vein so it hardens and eventually shrinks away. Recent evidence with foam sclerotherapy shows that the foam containing the irritating sclerosant quickly appears in the patients heart and lungs, and then in some cases travels through a patent foramen ovale to the brain. This has led to concerns about the safety of sclerotherapy for telangectasias and spider veins. In some cases stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
and transient ischemic attacks have occurred after sclerotherapy. Varicose veins
Varicose veins
Varicose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards . Leg muscles pump the veins to return blood to the heart, against the...
and reticular leg veins, if present, must be treated prior to any treatment of the telangiectasia. Varicose veins can be treated with foam sclerotherapy, endovenous laser treatment
Endovenous laser treatment
Endovenous laser treatment is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy.-Methods:...
, radiofrequency ablation
Radiofrequency ablation
Radio frequency ablation is a medical procedure where part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from the high frequency alternating current to treat a medical disorder...
or open surgery. The biggest risk, however, seems to occur with sclerotherapy, especially in terms of systemic risk of DVT, pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
, and stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
.
Another issue that arises with the use of sclerotherapy to treat spider veins is staining, shadowing, telangetatic matting and ulceration. In addition, incompleteness of therapy is common, requiring multiple treatment sessions.
Telangiectasias on the face are often treated with a laser. Laser therapy uses a light beam that is pulsed onto the veins in order to seal them off, causing them to dissolve. These light-based treatments require adequate heating of the veins. These treatments can result in the destruction of sweat glands, the risk increases with the number of treatments.
External links
- Varicose Veins and Spider Veins, Office on Women's Health, U.S. Department of Health and Human Services