Appearance of Lip Telangiectasias
Lip telangiectasias appear as small red-purple focal lesions representing prominent dilated blood vessels (venules, capillaries, or arterioles) visible on the vermilion border and mucosal surfaces of the lips. 1
Physical Characteristics
Morphology and Color:
- Telangiectasias present as small, visible vascular lesions that can be round, oval, dendritic (branching), or punctate (dot-like) in configuration 2
- The color ranges from red to purple, depending on the depth and type of vessel involved 1
- Some may appear as red telangiectatic macules (flat spots) against a tan or brown background in certain conditions 3
- In hereditary acrolabial telangiectasia, lips show bluish discoloration of the vermilion ridge with discrete telangiectatic lesions 4
Size and Distribution:
- These are small lesions representing dilated subpapillary vessels visible at the skin surface 1, 4
- On the lips specifically, they typically appear on the vermilion border (the red portion of the lip) and can extend to the oral cavity mucosa 3
- Histologically, they consist of extensive, dilated, horizontal subpapillary telangiectases that are postcapillary venules 4
Clinical Context and Significance
When Multiple Telangiectasias Are Present:
- Multiple telangiectasias at characteristic sites including lips, oral cavity, fingers, and nose constitute one of the four Curaçao diagnostic criteria for Hereditary Hemorrhagic Telangiectasia (HHT) 3
- In HHT, these lesions typically become visible around age 30 years, though epistaxis often begins earlier at mean age 11 years 3
- The presence of lip telangiectasias should prompt evaluation for systemic involvement, as they can serve as cutaneous markers for serious hereditary disorders 1
Symptomatic Presentation:
- Most lip telangiectasias are asymptomatic and cause primarily aesthetic concerns 2
- In HHT, however, these fragile vessels are prone to rupture and bleeding due to their thin walls and enlarged diameter 5
- The pattern of distribution, age of onset, and associated features help distinguish between benign hereditary telangiectasia and more serious systemic conditions 1
Important Clinical Pitfall
Never perform a biopsy on suspected telangiectasias in the lip area without first ruling out HHT or other bleeding disorders, as these lesions have a high risk of hemorrhage due to their vascular nature 5. The diagnosis is primarily clinical based on visual appearance and distribution pattern 2, 1.