Telangiectasia and Autoimmune Disease

Featured in the January, 2014 Scleroderma, Vasculitis & Myositis eNewsletter

Telangiectasia is a common condition that affects many otherwise healthy people. But can also be a sign of a more serious disease.

What is telangiectasia?

Telangiectasias (commonly known as "spider veins") are dilated or broken blood vessels located near the surface of the skin or mucous membranes. They often appear as fine pink or red lines, which temporarily whiten when pressed. "Matted" telangiectasias are clusters of these small dilated blood vessels that form a pink or red patch on the skin. Individuals who are otherwise healthy can develop this condition, and it is sometimes associated with varicose veins.

However, telangiectasias are also a classic feature of certain autoimmune diseases that affect the skin and other connective tissues (also called connective tissue diseases):

  • Scleroderma (also called systemic sclerosis), both in its limited and systemic forms
  • Dermatomyositis
  • Lupus – periungual telangiectasias (those around fingernails or toenails) are common in lupus patientss

What causes telangiectasia?

There are many different causes of telangiectasia. Any of the above-mentioned connective tissue diseases can cause it. But, perhaps most commonly, fair-skinned people develop them on areas their body that have chronic sun damage. They can also be found on the sides of the nose in othwerise healthy adults.

Pregnant women and people with any of the following conditions are more likely to develop telangiectasias:

  • Rosacea
  • Liver disease
  • Chronic systemic or topical corticosteroid use

Telangiectasia in scleroderma, dermatomyositis and lupus

Connective tissue diseases often cause telangiectasia to develop on the face and on fingernail or toenail folds (where the skin meets the nail).

Scleroderma

Patients with scleroderma may develop telangiectasias on the face, mucous membranes and hands. The condition occurs with both types of scleroderma:

  • Limited scleroderma – also called CREST syndrome, which stands for Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerosis and Telangiectasia. This primarily affects the skin of the face, hands and feet (with possible involvement of other organs).
  • Diffuse scleroderma – which has a more rapid onset and affects internal organs as well as the skin.

Telangiectasias become more numerous over time in both types of the disease, however, evidence suggests they occur more frequently in patients with limited scleroderma (CREST).

The precise factors that cause scleroderma patients to develop telangiectasias are unknown. However, some researchers believe that they are a manifestation of the body’s attempt to increase blood flow to organ tissues that have poor circulation. Thus, in scleroderma, telangiectasia may be a marker of ongoing vascular injury and failed repair.

Researchers have also identified the following facts and findings about telangiectasia in individuals with scleroderma:

  • The total number of telangiectasias has been shown to correlate with disease duration. In other words, the longer you have had the disease, the more telangiectasias you will likely develop.
  • The number of talengiectasias also correlates to the risk of developing pulmonary artery hypertension.
  • Telangiectasia is associated with the presence of the centromere antibody. This is an antibody to a portion of the chromosome that is active in cell division).
  • One study found that body image dissatisfaction was higher in scleroderma patients with numerous telangiectasia.

Dermatomyositis

In individuals with dermatomyositis, telangiectasias are typically found in sun-exposed areas, such as the V-shaped area of the neck and chest or in a "shawl" distribution over the shoulders, arms, and upper back. They can be associated with brown discoloration and thinning of the skin, a clinical finding called poikiloderma. This tends to occur in patients with long-standing dermatomyositis. Telangiectasia that appear as dilated loops of capillaries with the avascular areas (areas lacking blood vessels) on the fingernail folds are highly characteristic of both scleroderma and dermatomyositis. These findings can help physicians make an early diagnosis of these conditions.

Lupus

Telangiectasia of the nailfolds also occur in individuals with lupus and correlate with systemic disease activity and Raynaud’s phenomenon. Telangiectasias may also be found on the edges of lesions of discoid lupus. (This is a skin-only illness in which a specific rash, mostly a scarring rash of circular-shaped lesions, occurs without other lupus symptoms.)

What should I do if I have telangiectasia?

First, consult a dermatologist. Dermatologists commonly evaluate and treat patients who experience telangiectasias. Because symptoms that affect your skin can function as a "window" to your internal health, the dermatologist will determine the cause of the telangiectasia and start treatments or refer you to a rheumatologist if a connective tissue disease is suspected.

What can I expect from a doctor’s visit for telangiectasia?

The dermatologist will perform a history and physical examination. He or she will also review your medications and effects of associated health conditions.

Can telangiectasia be prevented?

Activities that trigger blushing or facial redness can worsen telangiectasia. Although they vary from person to person, common triggers include:

  • ultraviolet radiation (sunlight)
  • heat
  • cold
  • strong wind
  • alcohol consumption
  • smoking tobacco
  • hot drinks and foods
  • spicy foods
 

Products that result in irritation of the skin, such as abrasive cleansers, can also worsen telangiectasia.

Tips to help prevent telangiectasia

  • Protect your skin from the sun by applying sunscreen, and wearing sunglasses and a hat.
  • Use mild cleansers on your skin (such as those without dyes or fragrances).
  • Minimize your exposure to extreme hot or cold temperatures.
  • Avoid using topical steroids.

Are there treatments for telangiectasia?

Telangiectasias themselves actually pose no health problems or risk. However, there are treatments available to improve their appearance. These include:

  • Cosmetic Camouflage
    Cosmetic camouflage is a technique using topical creams or powders to conceal conspicuous skin conditions. Flesh-toned cover-up can immediately hide mild telangiectasia. For more prominent telangiectasia and facial redness, a slightly green-tinted foundation or moisturizer can neutralize the color. These compounds are cost effective and readily available. Look for products with the terms "redness concealer," "redness relief," or "redness solutions." Department stores with large make-up counters will often have a cosmetic therapist (make-up artist) trained to help patients with cosmetic camouflage. He or she will help create a regimen to match individual skin tone and hide telangiectasia.
  • Laser therapy
    This form of therapy uses a specific wavelength of light to selectively heat hemoglobin (the protein responsible for the red color of blood) and seal dilated blood vessels. Superficial facial telangiectasia are amenable to laser treatment. In scleroderma, due to thickened collagen fibers, telangiectasia are more resistant to laser therapy, but can be effectively cleared with multiple treatments. However, this does not prevent new telangiectasia from forming and subsequent treatments may be required to maintain the desired effects. Individuals considering laser therapy for telangiectasia should be aware that insurance plans deem these treatments to be "cosmetic" and do not yet cover this expense.
  • Electrodessication
    Electrodessication entails the insertion of fine needle into the blood vessel. An electrical current is then applied, which seals the vessel. This treatment may be helpful for simple facial telangiectasia; however, it has a higher risk of scarring compared to laser therapy.

Authors

Horatio Wildman, MD
Associate Professor of Clinical Dermatology, Weill Cornell Medical College

 

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