DermatologyTier 1Disease (DEADMAN)

Cutaneous manifestations of systemic diseases - spider naevi

Description

Spider naevus (spider angioma/telangiectasia) - central arteriole with radiating fine vessels, blanches with central pressure and refills from the centre outward
Distribution matters: >=1-2 lesions in the SVC distribution (face, neck, upper trunk, arms) is normal; numerous lesions, or any below the umbilicus, suggests chronic liver disease/hyperoestrogenism

Epidemiology

Common in pregnancy and in children (small numbers, physiological, oestrogen-driven, regress after delivery/childhood)
In adults outside pregnancy - numerous spider naevi correlate with severity of chronic liver disease

Aetiopathogenesis

Hyperoestrogenaemia - the unifying mechanism
- Physiological - pregnancy, childhood, puberty
- Pathological - cirrhosis (impaired hepatic oestrogen metabolism) -> relative oestrogen excess -> vascular dilatation
Local mechanism: oestrogen -> vasodilatation of a central arteriole with radiating capillaries

Diagnosis

Clinical - the diagnostic sign is the physical exam manoeuvre

Diascopy (glass slide/finger pressure) on the central punctum -> whole lesion blanches -> release -> refills centrifugally from the centre outward - confirms it is a spider naevus, not another vascular lesion
Count and map distribution - multiple lesions, or any outside the SVC distribution, prompts a liver disease work-up

When numerous/atypical - look for the whole chronic liver disease picture

Palmar erythema, gynaecomastia, caput medusae, testicular atrophy, Dupuytren's contracture, leukonychia, jaundice, ascites, asterixis - the constellation, not the sign in isolation, indicates cirrhosis
LFTs, synthetic liver function (albumin, INR), liver ultrasound/elastography if new numerous spider naevi in a non-pregnant adult

Management

No treatment needed for the naevi themselves in physiological contexts (pregnancy, childhood) - reassurance, expect regression
Pathological (cirrhosis-associated) - manage the underlying liver disease; the sign itself does not require directed treatment
Cosmetic laser ablation - option for persistent/bothersome lesions once the underlying cause is addressed or in physiological cases that fail to regress

Associations

Chronic liver disease/cirrhosis - alongside palmar erythema, gynaecomastia, caput medusae, testicular atrophy, Dupuytren's contracture
Pregnancy, oestrogen therapy, puberty (physiological)
Rarely - thyrotoxicosis, rheumatoid arthritis (weaker associations)

Natural history & complications

Physiological (pregnancy/childhood) - typically regress spontaneously (pregnancy: within weeks post-partum)
Cirrhosis-associated - persist and may increase in number as liver disease progresses; number correlates loosely with disease severity but is not itself prognostic in isolation
The clinical value lies in prompting a search for the broader chronic liver disease syndrome, not in the lesion's own natural history

6 more sections, plus exam facts

Premium unlocks every note across every specialty, and the full exam fact library behind it.

Get premium access