Telangiectases

Telangiectases

Also known as spider veins, angioectasias, broken blood vessels or capillaries

What are telangiectases?

Telangiectases are superficial blood vessels, which are visible with the naked eye. The majority can be improved with laser treatment or sclerotherapy.

Nasal telangiectases treated with pulse dye laser – images reproduced with permission of Dr Davin Lim

Nasal telangiectases treated with pulse dye laser – images reproduced with permission of Dr Davin Lim

What causes telangiectases?

They are caused by dilated blood vessels under the surface of the skin or in mucous membranes. These spots may occur spontaneously or as a result of various underlying medical conditions or procedures (see list below).

What do telangiectases look like?

They are small, blanchable red spots between 0.5 to1mm in diameter, which are visible to the naked eye. They occur on various parts of the body or mucous membranes depending on the underlying cause. The most commonly affected areas are the nose, cheeks, chin and legs.

What other problems can occur with telangiectases?

They often occur in isolation and are not associated with primary cutaneous disorders.

Some secondary causes include:

Physical associated telangiectases as a result of:

  • Actinic or sun damage
  • Pregnancy
  • Radiation therapy
  • Post-surgery along flap or excision lines

Blood vessels secondary to primary condition in:

  • Rosacea
  • Poikiloderma of civatte
  • Hormonal or pregnancy associated spider telangiectasia

Conditions associated with telangiectases include:

  • Connective tissue diseases, including Crest syndrome and Lupus
  • Hereditary hemorrhagic telangiectasia
  • Generalised essential telangiectasia
  • Bloom syndrome
  • Cockayne syndrome

How are telangiectases diagnosed?

Investigations are not always necessary as telangiectases are diagnosed from their typical appearance. However, if an underlying medical cause is suspected the dermatologist will determine if further investigations such as skin biopsies, imaging or blood tests are needed.

How are telangiectases treated?

Treatment is necessary only if the lesions cause symptoms or if they are a cosmetic concern.

Specific treatments include:

  • Camouflage cream

Colour matched makeup is an excellent method of covering up redness associated with telangiectases. Green-tinted foundations and creams are especially helpful in concealing redness.

  • Lasers

Laser therapy is an effective method for treating facial telangiectases. The correct types of lasers are readily available in many dermatologist practices. Lunchtime procedures can be organised depending on the extent of the area being treated.

    • 532 nm KTP laser can be used as a tracing laser for small to medium-sized telangiectases
    • 595 nm pulse dye laser is effective for diffuse erythema and small to medium-sized telangiectases
    • 755 nm Alexandrite lasers can be used for treatment-resistant telangiectases or in darker skin types
    • 1064 nm long pulse Nd YAG lasers can be used to treat deeper and larger telangiectasias
    • Other less commonly used lasers include the copper bromide laser and diode lasers.
  • Sclerotherapy is more effective in treating telangiectases on the legs.
  • Intense pulse light treatment (IPL)

IPL can be very effective in treating small to medium-sized facial telangiectases. Larger telangiectases respond better to longer wavelength lasers.

  • Hyfrectation and electrocautery

Fine needle hyfrector may be used but there are more side effects than with laser therapy.

What is the likely outcome of telangiectases?

They are harmless and the vast majority of cases are not associated with an underlying medical condition. Laser treatment, when performed by a dermatologist, often removes these spots safely and effectively.

This information has been written by Dr Davin S Lim and Dr Michelle Rodrigues

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