Spider angiomas, also called spider nevi, are common and benign tumors, usually bright red and small (1 mm), made of blood vessels. According to Dr. Mark Crowe, M.D., a spider angioma consists of a central arteriole with radiating thin-walled vessels; the entire lesion is usually 0.5-1 cm in diameter. Commonly found on the face, neck, upper part of the trunk, and arms, spider angiomas may be present in as many as 10-15% of healthy adults and children. Usually, spider angiomas resolve themselves in young children, but are usually permanent without treatment in adults.
Spider angiomas may be caused by a number of factors. In women, spider angiomas normally develop during pregnancy, or while taking oral contraceptives, in both cases due to increased levels of estrogens. According to a 1999 study cited in the Journal of Postgraduate Medicine, Li et al. found that patients with elevated levels of estrogens and certain vasodilators demonstrated elevated levels of substance P; they postulated that this substance may play an important role in the pathogenesis of spider angiomas. However, spider angiomas usually resolve spontaneously within six months postpartum, or within six to nine months after discontinuing use of oral contraceptives. Other causes of spider angioma include hepatic (liver) cirrhosis, malignant liver disease, and other hepatic dysfunctions.
Cosmetic treatment of spider angiomas is conducted via electrodessication (the sealing off of blood vessels by monopolar high frequency electric current), intense pulsed light (IPL) laser, or liquid nitrogen treatment. According to Dr. Crowe, the risk of a scar is slightly higher with electrodessication than laser, but both generally yield desirable results. In electrodessication, the site is first briefly anesthesized by intradermal injection. Following, a 30-gauge needle is inserted directly into the central papule. The doctor moves the blood out of the spider by pressing firmly on the lesion and moving his finger to one side; following, the central arteriole is sealed off by electric current. In laser treatment, the intense pulsed dye laser heats the hemoglobin in the blood cells, which in turn cauterizes the vessels that make up the angioma. Angiomas can also be treated with liquid nitrogen therapy. Liquid nitrogen is a cold, liquefied gas that is sprayed on the skin with a spray gun; this works by freezing and destroying the blood vessels. According to the University of Illinois, removal of a spider angioma by any method may cause bruising, tenderness, focal changes in skin pigment, or tiny scars, and some angiomas may reappear after treatment.
Women with purely cosmetic concerns of spider angiomas should be advised to quit oral contraceptives (to lower the levels of estrogen in their blood). All patients with spider angiomas should reduce alcohol consumption. In a 1994 study by Ino et al., it was found that higher numbers of spider angiomas occurred in patients with alcoholic cirrhosis than those with cirrhosis due to hepatitis C viral infection. Patients are advised to speak to their dermatologist about whether electrodessication, laser, or liquid nitrogen are viable treatments for them. If professional treatment is not sought, a cover-up cream used for melasma or port-wine stains may be advisable, such as Neostrata Coverblend or Dermablend for Severe Skin Flaws.
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