What is the management of spider nevi (telangiectasias) in pregnancy?

Management of Spider Nevi in Pregnancy

Spider nevi (telangiectasias) in pregnancy typically do not require active treatment as they are benign and usually resolve spontaneously after delivery.

Understanding Spider Nevi in Pregnancy

Spider nevi are a type of telangiectasia that commonly appear during pregnancy due to the hyperestrogenic state. They are characterized by:

• Central arteriole with radiating small vessels resembling a spider's legs
• Most commonly found on the face, neck, chest, and arms
• Appear as small (2-10mm) red lesions with radiating branches
• May show pulsatility on examination

Evaluation of Spider Nevi

When evaluating spider nevi in pregnancy:

• Document the extent, pattern, and timeline of appearance
• Assess for other associated skin changes
• Consider dermoscopic examination to confirm diagnosis 1
• Three dermoscopic patterns may be observed: network, star, and looping 2

Management Approach

1. Reassurance and Observation

   • Spider nevi are benign vascular lesions that typically resolve spontaneously within 3-6 months postpartum 1
   • No specific treatment is required during pregnancy unless desired for cosmetic reasons

2. Distinguishing from Concerning Lesions

   • Any changing melanocytic nevus during pregnancy should be evaluated with the same level of concern as in non-pregnant patients 3, 1
   • If a lesion shows concerning features (asymmetry, border irregularity, color variation, diameter >6mm, evolution), consider biopsy 3

3. Sun Protection

   • Recommend appropriate sun-protective measures to minimize pigmentation changes and vascular response 3, 1
   • Advise use of broad-spectrum sunscreen, protective clothing, and avoiding peak sun exposure

Treatment Options (If Desired for Cosmetic Reasons)

Most treatment options should be deferred until after pregnancy and breastfeeding:

• Laser therapy: Pulsed dye laser is the treatment of choice but should be postponed until after pregnancy
• Electrodesiccation: Can be considered postpartum
• Microneedling: Has been reported as effective for spider veins but should be deferred until after pregnancy 4

Special Considerations

• Spider nevi may be associated with elevated estrogen levels during pregnancy
• Unlike melanocytic nevi, spider nevi do not require biopsy unless their appearance is atypical or concerning for another diagnosis
• Multiple spider nevi (>5) outside of pregnancy may be associated with liver disease, but isolated spider nevi during pregnancy are typically physiologic

Follow-up

• Routine prenatal visits are sufficient for monitoring
• Document any changes in size or appearance
• Reassess at postpartum visit to confirm resolution

Common Pitfalls to Avoid

• Overtreatment of a benign, self-resolving condition during pregnancy
• Confusing spider nevi with other vascular lesions or melanocytic nevi
• Performing unnecessary invasive procedures during pregnancy
• Failing to provide reassurance about the benign and temporary nature of these lesions

Spider nevi represent a normal physiological response to the hormonal changes of pregnancy and typically do not require intervention beyond reassurance and monitoring.