HISTORY
Chief complaint: presenting for diagnosis and therapeutic options.
History of Present Illness
A 52-year-old male with a history of alcoholism presents with multiple blanching lesions on the trunk. Prior treatment: none. His primary symptom: none. Prior biopsy: none.
IMAGE QUALITY ASSESSMENT
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT
One image was provided of Problem A. The image clearly shows multiple macules with red-dot centers and red sunburst-like extensions (See Figure 1).
INTERPRETATION OF IMAGES
Findings
The morphology and distribution of the lesions are most consistent with the diagnosis of spider angioma.
RECOMMENDATIONS
Skin Care and Treatment Recommendations
None.
Type of Visit
Return to primary care provider for primary work-up for liver disease (if this has not been performed) and reassurance of the benign nature of the skin lesions and to discuss treatment options for cosmesis, if desired by the patient.
CLINICAL PEARL
Spider angiomas (aka nevus araneus) are common benign vascular lesions. The presence of multiple lesions can be indicative of liver disease, thyrotoxicosis, or estrogen therapy. As the name suggests, the red-dot center of the central red arteriole represents the spider body, whereas the extending radial pattern of the off-shooting capillaries represents the spider legs. These vascular lesions are blanchable and can be well visualized to disappear by diascopy (compression with a glass slide; Sweeney, 2014).
In addition to laboratory evaluation for an associated liver disease, a comprehensive physical examination is recommended, which would include palpation of the liver and spleen, evaluation for ascites, muscle and gonadal atrophy, and palmar erythema.
Of interest, reports have been described whereby spider angioma have resolved and regressed after liver transplantation. Most of these asymptomatic lesions, however, do not require treatment. An especially cosmetically troublesome lesion may be treated effectively by either laser therapy or light electrodessication of the compressed central arteriole.
The standardized teledermatology reader report format is available for authors on the submissions Web site and outlined in Table 1.
REFERENCES