Telangiectasias/Angiomas

Telangiectasias/Angiomas: Excerpt from Field Guide to Bedside Diagnosis

Differential Overview

❑ Acne rosacea

❑ Actinic damage

❑ Essential/venous hypertension

❑ Cherry angioma

❑ Senile angioma

❑ Pregnancy

❑ Cirrhosis

❑ Systemic lupus erythematosus

❑ Dermatomyositis

❑ Scleroderma

❑ Kaposi sarcoma

❑ Poikiloderma

❑ Port wine stain

❑ Cavernous hemangioma

❑ Venous lake

❑ Carcinoid

❑ Ataxia-telangiectasia

❑ Hereditary hemorrhagic telangiectasia

Diagnostic Approach

Linear telangiectasias are simple red or blue lines that blanch with pressure and disappear with diascopy. They are common with actinic damage, rosacea, carcinoid, ataxia-telangiectasia, or cutaneous inflammation (such as discoid lupus).

Spider angiomata have a central pulsating punctum (seen with diascopy), radial legs, and a halo of pallor caused by a vascular steal phenomenon.

Periungual nailfold telangiectasias, resembling glomeruli on 10-fold magnification, are found in lupus, scleroderma, and dermatomyositis.

Clinical Findings

Acne rosacea  Linear facial telangiectasias are associated with flushing, erythema, papulopustules, and rhinophyma.

Actinic damage  Damage occurs in sun-exposed areas and is associated with hyperpigmentation and keratoses.

Essential/venous hypertension  Venous stars appear as linear telangiectasias in netlike sheets on the legs. They are more common in women.

Cherry angioma  They appear in the third decade as 1 to 3 mm, red, soft, globular lesions that blanch when the surrounding skin is stretched.

Senile angioma  Raspberry red and raised, they do not empty or blanch. They increase in number and size with age.

Pregnancy  Spider angiomas occur in the upper half of the body, and venous stars occur on the legs.

Cirrhosis  Spider angioma occur on the chest and upper back. Other stigmata of cirrhosis are usually present, such as ascites, a prominent venous pattern on the abdomen, and palmar erythema.

Systemic lupus erythematosus  Tortuous nailbed telangiectasias look like glomeruli when magnified. They occur in association with classic lupus findings such as malar rash and Raynaud phenomenon.

Dermatomyositis  Periungual telangiectasias, nailfold erythema, ragged cuticles, and fingertip tenderness develop. A violet/heliotrope eyelid rash and Gottron papules on the extensor surfaces of the fingers are characteristic findings.

Scleroderma  Mat (interconnected) telangiectasias appear on the face along with dilated nailbed telangiectasias. The skin on the face and hands develops a shiny, bound-down appearance.

Kaposi sarcoma  A purple papule/plaque appears in a patient with HIV infection.

Poikiloderma  It appears as a patch of skin with reticulated hypo or hyperpigmentation, wrinkling due to epidermal atrophy and telangiectasias. Causes include ionizing radiation, dermatomyositis, and xeroderma pigmentosum.

Port wine stain  The patches are broad, pale pink to deep purple, and rarely cross the midline. A trigeminal distribution may signal intracranial angioma, especially with ipsilateral ocular abnormalities (Sturge-Weber syndrome).

Cavernous hemangioma  Large strawberry hemangiomas are more prominent at birth and tend to fade with age.

Venous lake  It is a bluish lesion on the lower lip. On the scrotum it is called angiokeratoma when accompanied by hyperkeratosis.

Carcinoid  Episodes of recurrent flushing of the head and neck lead to facial telangiectasias that may mimic acne rosacea.

Ataxia-telangiectasia  Linear telangiectasias appear on the bulbar conjunctiva during childhood and eventually on the ears, cheeks, and flexural areas.

Hereditary hemorrhagic telangiectasia  Telangiectasias appear in adulthood on the mucous membranes and nail beds. They are dark red, slightly palpable, arteriovenous malformations. When the overlying skin is stretched, an eccentric punctum with radiating legs may be seen. They are associated with epistaxis, gastrointestinal hemorrhage, and pulmonary AV fistulas with hypoxemia.

Book Source Details

• Book Title: Field Guide to Bedside Diagnosis
• Author(s): David S. Smith
• Year of Publication: 2007
• Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.

More About Ataxia Telangiectasia

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Field Guide to Bedside Diagnosis Authors: David S. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-78178-165-5

 » Next page: Ataxia (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

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