What is a Telangiectasia
A telangiectasia is a small dilated blood vessel (venule, capillary, or arteriole) that appears as a visible red-purple focal lesion on the skin or mucous membranes, measuring less than 1 mm in diameter. 1
Physical Characteristics
- Telangiectasias appear as small red-purple focal lesions representing permanently dilated superficial blood vessels visible through the skin or mucous membrane surface 2
- These lesions measure less than 1 mm in diameter when fully developed, distinguishing them from larger reticular veins (1-3 mm) and varicose veins (≥3 mm) 1
- The vessels involved can be venules, capillaries, or arterioles, with thin walls that are prone to rupture and bleeding in certain conditions 3
- Some telangiectasias may appear as red telangiectatic macules within a tan or brown background, particularly in rare variants like telangiectasia macularis eruptiva persistans 4
Clinical Distribution and Common Locations
- Telangiectasias commonly develop on characteristic sites including the lips, oral cavity, tongue, hard palate, fingers, nose, and ears 3, 5
- They occur in 43% of men and 55% of women as isolated findings (spider veins), representing a common benign condition 1
- The location and distribution pattern, combined with careful history, often helps distinguish between benign isolated lesions and those indicating serious underlying disorders 6
Clinical Significance: When to Worry
Multiple telangiectasias at characteristic sites constitute one of the four Curaçao diagnostic criteria for Hereditary Hemorrhagic Telangiectasia (HHT), a potentially life-threatening autosomal dominant disorder. 3, 4
Red Flags Requiring Further Evaluation:
- Recurrent spontaneous epistaxis (nosebleeds) combined with telangiectasias suggests HHT and requires immediate specialist referral 3, 5
- Family history of recurrent nosebleeds or HHT in combination with visible telangiectasias warrants comprehensive screening for arteriovenous malformations 3, 5
- Multiple telangiectasias appearing at characteristic sites (lips, oral mucosa, fingers, ears) should trigger application of Curaçao criteria 5
- Telangiectasias appearing in childhood (typically by age 5) with progressive neurological deterioration may indicate Ataxia Telangiectasia 5
Critical Pitfall to Avoid:
Never dismiss isolated ear or facial telangiectasias without screening for HHT using Curaçao criteria, as this represents a potentially life-threatening condition with asymptomatic arteriovenous malformations that can cause stroke or cerebral abscess 5
Primary vs. Secondary Telangiectasias
Primary (Benign) Telangiectasias:
- Occur spontaneously without underlying disease 6
- Include common spider veins on legs and face 1
- Primarily a cosmetic concern 7
Secondary Telangiectasias (Markers of Underlying Disease):
- Post-radiation therapy: Develop in irradiated tissues, often appearing years after treatment, with risk determined by radiation dose 5
- Prolonged topical steroid application: Result from chronic corticosteroid-induced skin changes 6
- Sun damage: Chronic actinic damage causes vessel dilation 6
- Hereditary Hemorrhagic Telangiectasia: Symptoms typically appear around age 30, with epistaxis starting at mean age 11 years 4
- Systemic diseases: Can serve as cutaneous markers for serious internal conditions or malignancies 6, 2
When to Refer for Specialist Evaluation
Refer to an HHT specialist if ≥2 Curaçao criteria are present (epistaxis, multiple telangiectasias, visceral AVMs, or first-degree relative with HHT) for comprehensive organ screening including pulmonary, cerebral, and hepatic arteriovenous malformations 5