A spider angioma is a fiery red vascular lesion with an elevated central body, branching spiderlike legs, and a surrounding flush. A form of telangiectasia, this characteristic lesion ranges from a few millimeters to several centimeters in diameter and may occur singly or in multiples. Spider angiomas usually appear on the face and neck; less commonly, they occur on the shoulders, thorax, arms, backs of the hands and fingers, and mucous membranes of the lips and nose. They rarely appear below the waist or on the lips, ears, nail beds, or palms. (See Recognizing a spider angioma.)
In most cases, spider angiomas are associated with cirrhosis but are also found in hyperestrogenic states such as pregnancy or in those taking hormonal contraceptives. They may erupt in the second or third month of pregnancy, enlarge and multiply, then disappear about 6 weeks after delivery. Occasionally, a few lesions may persist. These lesions may also appear in elderly patients—but they’re smaller and fewer in number (nine or fewer). They may persist indefinitely or spontaneously disappear.
Begin your examination by asking the patient how long he has had the spider angiomas and where they’re located. Then carefully examine him yourself, noting the size and location of the angiomas. On palpation, the angiomas may be slightly warmer than the surrounding skin and may have a pulsating central body. Also, check for other skin abnormalities, such as jaundice, dryness, and palmar erythema.
Multiple spider angiomas are a hallmark of cirrhosis. They’re typically a late sign, enlarging and multiplying as the disorder progresses. Associated signs and symptoms are widespread, varying with the degree of hepatic insufficiency and related portal hypertension. Splenomegaly and hematemesis, for example, point to portal hypertension.
Other skin effects include severe pruritus and dryness, palmar erythema, and decreased tissue turgor. Cardinal hepatic effects include jaundice, hepatomegaly, ascites, and leg edema. Right-upper-quadrant pain that worsens when the patient sits up or leans forward is common. The patient may also display key signs of hepatic encephalopathy, such as slurred speech, asterixis, fetor hepaticus, and decreased level of consciousness that progresses to coma. The male patient may develop testicular atrophy, gynecomastia, and loss of chest and axillary hair; the female patient may have menstrual irregularities.
Treatment isn’t indicated for spider angiomas during pregnancy. However, cautery, electrodesiccation, or freezing may be used to treat them in the patient with cirrhosis.
Occasionally, spider angiomas occur in normal children. Typically, they’re small and few, appearing on the backs of the hands and forearms.
Although spider angiomas may appear normally in elderly persons, they’re usually associated with liver disorders.
Advise the patient that spider angiomas may recur and that vigorous electrodesiccation may cause pitting edema.
![Spider angioma [Arterial spider, spider nevus, spider telangiectasia, stellate angioma, vascular spider] - 2728.png](/bookimages/8/2728.png)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9 
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