Spider angioma

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Spider angioma
Other namesNevus araneus, spider nevus, vascular spider, spider telangiectasia [1]
Spider nevus (cropped).jpg
Non-benign angiomas indicating cirrhosis
Specialty Dermatology   OOjs UI icon edit-ltr-progressive.svg

A spider angioma or spider naevus (plural: spider naevi), also nevus araneus, is a type of telangiectasis [2] (swollen, spider-like blood vessels on the skin) found slightly beneath the skin's surface, often containing a central red spot and deep reddish extensions (see Blood color) which radiate outwards like a spider's web or a spider's legs. They are common and often benign, presenting in around 10–15% of healthy adults and young children. [3] However, having more than three spider angiomas is likely to be abnormal and may be a sign of liver disease and/or hepatitis C (HCV virus); [4] it also suggests the probability of esophageal varices. [5]

Contents

Signs and symptoms

Nevus araneus (spider nevus): in the center of the red lesion a small (1 mm) red papule is visible, surrounded by several distinct radiating vessels. Pressure on the lesion causes it to disappear, however blanching is replaced by rapid refill from the central arteriole when pressure is released. Spidernevus.jpg
Nevus araneus (spider nevus): in the center of the red lesion a small (1 mm) red papule is visible, surrounded by several distinct radiating vessels. Pressure on the lesion causes it to disappear, however blanching is replaced by rapid refill from the central arteriole when pressure is released.
Multiple spider angiomas SpiderAngioma.jpg
Multiple spider angiomas

Spider angiomas are found only in the distribution of the superior vena cava, and are thus commonly found on the face, neck, upper part of the torso, and arms.[ citation needed ]

Cause

Spider angiomas form due to failure of the sphincteric muscle surrounding a cutaneous arteriole. The central red dot is the dilated arteriole and the red "spider legs" are small capillaries carrying away the freely flowing blood. If momentary pressure is applied, it is possible to see the emptied capillaries refilling from the center. No other angiomas show this phenomenon. [7]

The dilation, in turn, is caused by increased estrogen levels in the blood. Many pregnant women and women using hormonal contraception have spider angiomas, which is due to high estrogen levels in their blood. Individuals with significant liver disease also show many spider angiomas, as their liver cannot metabolize circulating estrogens, specifically estrone, which derives from the androgen androstenedione. [3] About 33% of patients with cirrhosis have spider angiomas. [8]

Hepatitis C is an infection that can lead to irreversible liver damage. The hepatitis C virus (HCV) spreads through contaminated blood, and people are often infected by sharing drug paraphernalia or unsanitized tattoo guns and needles, piercing equipment, or manicure tools. [4] To make matters worse, symptoms of HCV can take years to appear, and this is likely why most of those infected with hepatitis C do not even realize that they are infected, and can continue to spread the virus unknowingly. [4]

Unfortunately, many symptoms do not start to appear until some damage to the liver has been done. Unlike in the past when hepatitis C was not curable and continued to worsen as years passed, today most positive hepatitis C virus (HCV) cases (95–98%) are now curable by taking a fairly newer treatment in the form of a prescribed daily oral medication for the full duration of 12 weeks. [4] This treatment is usually well tolerated, with little to no side effects.

Spider angiomas (spider-like blood vessels on the skin) are one of the main symptoms caused by a HCV infection. Discovering an infected patient with hepatitis C early on in the infection phase increases the chances of the virus being successfully treated and cured by oral medication. [4] Some patients can be infected with hepatitis C for decades without knowing, and without experiencing any signs or symptoms of the virus. [4] While hepatitis A and B have a protective vaccine available, there are no vaccines available to protect against HCV. Once contracted, if left untreated, hepatitis C can cause the liver to swell or become inflamed, making it difficult to function adequately in order to properly filter out chemicals and toxins. When the HCV infection turns chronic, it can cause full-blown cirrhosis of the liver (scarring of the liver), making it difficult for the liver to filter out waste and to store nutrients. [4] This can also lead to liver cancer and eventually will lead to liver failure. [4]

Diagnosis

Diagnosis is by clinical examination. Spider naevi are most commonly seen by general practitioners, or dermatologists. Whilst a lesion can be identified as a spider naevus, this is not a diagnosis in itself. The clinical picture should be indicative of whether there is underlying disease that should be investigated.[ citation needed ]

Treatment

Spider angiomas are asymptomatic and usually resolve spontaneously. This is common in the case of children, although they may take several years to disappear. If the spider angiomas are associated with pregnancy, they may resolve after childbirth. In women taking oral contraceptives, they may resolve after stopping these contraceptives.[ citation needed ]

For spider angiomas on the face, techniques such as electrodesiccation and laser treatment can be used to remove the lesion. [9] There is a small risk of a scar; however, it usually leaves nothing.

See also

Related Research Articles

<span class="mw-page-title-main">Hepatitis</span> Inflammation of the liver

Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), poor appetite, vomiting, tiredness, abdominal pain, and diarrhea. Hepatitis is acute if it resolves within six months, and chronic if it lasts longer than six months. Acute hepatitis can resolve on its own, progress to chronic hepatitis, or (rarely) result in acute liver failure. Chronic hepatitis may progress to scarring of the liver (cirrhosis), liver failure, and liver cancer.

<span class="mw-page-title-main">Hepatitis C</span> Human viral infection

Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection period, people often have mild or no symptoms. Early symptoms can include fever, dark urine, abdominal pain, and yellow tinged skin. The virus persists in the liver, becoming chronic, in about 70% of those initially infected. Early on, chronic infection typically has no symptoms. Over many years however, it often leads to liver disease and occasionally cirrhosis. In some cases, those with cirrhosis will develop serious complications such as liver failure, liver cancer, or dilated blood vessels in the esophagus and stomach.

<span class="mw-page-title-main">Hepatology</span> Medical specialty

Hepatology is the branch of medicine that incorporates the study of liver, gallbladder, biliary tree, and pancreas as well as management of their disorders. Although traditionally considered a sub-specialty of gastroenterology, rapid expansion has led in some countries to doctors specializing solely on this area, who are called hepatologists.

<span class="mw-page-title-main">Viral hepatitis</span> Liver inflammation from a viral infection

Viral hepatitis is liver inflammation due to a viral infection. It may present in acute form as a recent infection with relatively rapid onset, or in chronic form, typically progressing from a long-lasting asymptomatic condition up to a decompensated hepatic disease and hepatocellular carcinoma (HCC).

<span class="mw-page-title-main">Liver disease</span> Medical condition

Liver disease, or hepatic disease, is any of many diseases of the liver. If long-lasting it is termed chronic liver disease. Although the diseases differ in detail, liver diseases often have features in common.

<span class="mw-page-title-main">Gastrointestinal disease</span> Illnesses of the digestive system

Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum; and the accessory organs of digestion, the liver, gallbladder, and pancreas.

<span class="mw-page-title-main">Angioma</span> Benign tumors derived from cells composing or surrounding blood or lymph vessels

Angiomas are benign tumors derived from cells of the vascular or lymphatic vessel walls (endothelium) or derived from cells of the tissues surrounding these vessels.

<span class="mw-page-title-main">Telangiectasia</span> Small dilated blood vessels

Telangiectasias, also known as spider veins, are small dilated blood vessels that can occur near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. These dilated blood vessels can develop anywhere on the body, but are commonly seen on the face around the nose, cheeks and chin. Dilated blood vessels can also develop on the legs, although when they occur on the legs, they often have underlying venous reflux or "hidden varicose veins". When found on the legs, they are found specifically on the upper thigh, below the knee joint and around the ankles.

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) co-infection is a multi-faceted, chronic condition that significantly impacts public health. According to the World Health Organization (WHO), 2 to 15% of those infected with HIV are also affected by HCV, increasing their risk of morbidity and mortality due to accelerated liver disease. The burden of co-infection is especially high in certain high-risk groups, such as intravenous drug users and men who have sex with men. These individuals who are HIV-positive are commonly co-infected with HCV due to shared routes of transmission including, but not limited to, exposure to HIV-positive blood, sexual intercourse, and passage of the Hepatitis C virus from mother to infant during childbirth.

<span class="mw-page-title-main">Liver cancer</span> Medical condition

Liver cancer, also known as hepatic cancer, primary hepatic cancer, or primary hepatic malignancy, is cancer that starts in the liver. Liver cancer can be primary in which the cancer starts in the liver, or it can be liver metastasis, or secondary, in which the cancer spreads from elsewhere in the body to the liver. Liver metastasis is the more common of the two liver cancers. Instances of liver cancer are increasing globally.

<span class="mw-page-title-main">Hepatitis B</span> Human viral infection

Hepatitis B is an infectious disease caused by the Hepatitis B virus (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.

<span class="mw-page-title-main">Cirrhosis</span> Chronic disease of the liver, characterized by fibrosis

Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is a condition of the liver in which the normal functioning tissue, or parenchyma, is replaced with scar tissue (fibrosis) and regenerative nodules as a result of chronic liver disease. Damage to the liver leads to repair of liver tissue and subsequent formation of scar tissue. Over time, scar tissue and nodules of regenerating hepatocytes can replace the parenchyma, causing increased resistance to blood flow in the liver's capillaries—the hepatic sinusoids—and consequently portal hypertension, as well as impairment in other aspects of liver function. The disease typically develops slowly over months or years.

<span class="mw-page-title-main">Blue rubber bleb nevus syndrome</span> Medical condition

Blue rubber bleb nevus syndrome is a rare disorder that consists mainly of abnormal blood vessels affecting the skin or internal organs – usually the gastrointestinal tract. The disease is characterized by the presence of fluid-filled blisters (blebs) as visible, circumscribed, chronic lesions (nevi).

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Infections of the hepatitis C virus (HCV) in children and pregnant women are less understood than those in other adults. Worldwide, the prevalence of HCV infection in pregnant women and children has been estimated to 1-8% and 0.05-5% respectively. The vertical transmission rate has been estimated to be 3-5% and there is a high rate of spontaneous clearance (25-50%) in the children. Higher rates have been reported for both vertical transmission. and prevalence in children (15%).

<span class="mw-page-title-main">Dasabuvir</span> Chemical compound

Dasabuvir, sold under the brand name Exviera, is an antiviral medication for the treatment of hepatitis C. It is often used together with the combination medication ombitasvir/paritaprevir/ritonavir specifically for hepatitis C virus (HCV) type 1. Ribavirin may also additionally be used. These combinations result in a cure in more than 90% of people. It is taken by mouth.

Elbasvir/grazoprevir, sold under the brand name Zepatier, is a fixed-dose combination for the treatment of hepatitis C, containing elbasvir and grazoprevir. It is used to treat chronic hepatitis C virus (HCV) genotypes 1 or 4 infection in both treatment-naïve and treatment-experienced patients.

Hepatitis C virus (HCV) genotypes refer to the genetic variations that occurs in the hepatitis C virus. Hepatitis C is a contagious disease that primarily affects the liver, causing severe damage as the disease progresses. It is caused by the Hepatitis C virus, a small, enveloped RNA virus. The transmission of hepatitis C is through the contact with the blood of the infected person, for example by sharing the needles or by using non-sterile medical equipment. HCV is transmitted globally because of the high infection rate and is also associated with a high mortality rate. The World Health Organization indicates the 3.3% of the world population is infected by the HCV virus. Statistical records show that there are about 13 million HCV affected persons in Сhina, 3.5 million affected persons in the United States, and about 10 million people are affected by HCV in Pakistan. In all cases, the viral genotype of the HCV stays the same, occasionally mutations do occur making the treatment more complex by targeting the changes in the genotype. Hepatitis C virus genotype is considered more common than the Hepatitis B virus infection contributing to more than a million cases annually and is considered one of the major reason for liver transplantation in United States. Some of the HCV genotypes may develop in people without symptoms leading to dangerous conditions like liver cirrhosis causing a permanent damage to liver and the unnoticed HCV conditions will affect brain, joints, blood vessels, bones, and kidneys.

Sofosbuvir/velpatasvir, sold under the brand name Epclusa among others, is a fixed-dose combination medication for the treatment of hepatitis C in adults. It combines sofosbuvir and velpatasvir. It is more than 90% effective for hepatitis C genotypes one through six. It also works for hepatitis C in those who also have cirrhosis or HIV/AIDS. It is taken by mouth.

References

  1. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 1621–22. ISBN   978-1-4160-2999-1.
  2. ↑ "spider angioma" at Dorland's Medical Dictionary
  3. 1 2 Nevus Araneus at eMedicine
  4. 1 2 3 4 5 6 7 8 "What Are Signs And Symptoms Of Hepatitis C". Recovery Care Blog - What Are Signs And Symptoms Of Hepatitis C. March 16, 2021. Retrieved January 3, 2022.
  5. ↑ Udell, Jacob A.; Wang, Charlie S.; Tinmouth, Jill; FitzGerald, J. Mark; Ayas, Najib T.; Simel, David L.; Schulzer, Michael; Mak, Edwin; Yoshida, Eric M. (22 February 2012). "Does This Patient With Liver Disease Have Cirrhosis?". JAMA. 307 (8): 832–842. doi:10.1001/jama.2012.186. PMID   22357834 . Retrieved 11 April 2018– via jama.jamanetwork.com.
  6. ↑ Sand, M; Sand, D; Thrandorf, C; Paech, V; Altmeyer, P; Bechara, FG (4 June 2010). "Cutaneous lesions of the nose". Head & Face Medicine. 6: 7. doi: 10.1186/1746-160X-6-7 . PMC   2903548 . PMID   20525327.
  7. ↑ McCluskey D R Journal of the Royal College of Physicians of Edinburgh 2004, 34: 104 - 105
  8. ↑ Li CP, Lee FY, Hwang SJ, et al. (1999). "Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function". Scand. J. Gastroenterol. 34 (5): 520–3. doi:10.1080/003655299750026272. PMID   10423070.
  9. ↑ Geronemus, R. G. (1991). "Treatment of spider telangiectases in children using the flashlamp-pumped pulsed dye laser". Pediatr Dermatol. 8 (1): 61–3. doi:10.1111/j.1525-1470.1991.tb00843.x. PMID   1862028.
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