Telangiectasias are small, permanently widened blood vessels that show as fine red lines or spots on the skin or mucosa. Most come from sun damage or rosacea, but they can point to liver disease, systemic sclerosis or hereditary hemorrhagic telangiectasia.
Key symptoms
- Fine red or purple lines on the face, legs or chest
- Usually painless; concern is mostly cosmetic
- Frequent nosebleeds in hereditary hemorrhagic telangiectasia
- Fatigue from anemia if there is hidden bleeding
What you find on exam
- Fine vessels that blanch with pressure
- Spider angiomas with a central red dot on the upper body (liver disease, pregnancy)
- Small red spots on the lips, tongue and fingertips (hereditary hemorrhagic telangiectasia)
- Skin tightening of the fingers and face (systemic sclerosis)
- Signs of liver disease: jaundice, palmar erythema, ascites
Tests
- Often none if the cause is clear, such as sun damage or rosacea
- Liver function tests if spider angiomas are present
- Blood count and iron studies if bleeding is suspected
- ANA and anticentromere antibodies if systemic sclerosis is suspected; genetic testing for HHT
Treatment basics
- Treat the cause and protect the skin from the sun
- Pulsed dye laser or intense pulsed light for facial vessels
- Sclerotherapy for leg vessels
- Hereditary hemorrhagic telangiectasia: iron, nosebleed care and screening for vascular malformations
Red flags
- Repeated nosebleeds with a family history of the same (HHT)
- Many spider angiomas with jaundice or a swollen belly
- Raynaud phenomenon, skin tightening or trouble swallowing
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.