Telangiectasias are enlarged red intradermal veins (spider veins) with a diameter of 0,1 mm to 0,4 mm and a depth of 0,4 mm. They are the most common form of venous circulation disorders, which is more common in women. The risk factors include the patient’s age and lifestyle.
It is the most common form of venous circulation disorders occurring more often in women, and colloquially called spider veins. The more frequent occurrence of this ailment in women is related to the relaxing effect of estrogen on the muscles of the vessels, which leads to their dilatation.
It is estimated that this form of venous insufficiency affects 40% to 50% of the population in industrialized countries. Telangiectasia can take different forms depending on the type of dilated vessel:
- vivid red (capillaries);
- sinophilic (veins).
Rosacea is considered to be the most extensive example of telangiectasia. In its course, vascular changes can spread to the entire face, neck and décolleté.
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The causes of telangiectasia
The appearance of telangiectasia on the skin is the result of damage to the capillaries due to the transmission of increased venous pressure from insufficient network veins, varicose veins, and also due to arteriovenous fistulas at the capillary level. In some cases, they coexist with genetically determined diseases, sometimes of a nominal nature, as a result of systemic diseases or as a therapeutic complication (e.g. after steroid therapy).
The causes of spider veins related to skin diseases can be divided in terms of the macroscopic appearance of dilated blood vessels:
- stellate hemangioma – occurs during pregnancy or spontaneously,
- linear telangiectasias – rosacea, basal cell epithelioma, venous hypertension, spontaneous telangiectasia, skin photoaging;
- poikilodermia (these are reticulated discolorations) – damage caused by ionizing radiation, vascular atrophy of the skin.
Systemic causes are divided into:
- poikilodermia – skin T-cell lymphoma, dermatomyositis;
- linear telangiectasia – carcinoid syndrome, ataxia-telangiectasia syndrome, mastocytosis;
- stellate hemangioma – cirrhosis of the liver;
- macular telangiectasia – CREST syndrome;
- periungual telangiectasia – systemic lupus erythematosus, dermatomyositis, Rendu-Osler-Weber disease;
- follicular telangiectasia – hereditary hemorrhagic angioma;
Risk factors of telangiectasia
The most common risk factors are:
- patient’s sex – the ailment occurs much more often in women than in men,
- patient’s age – although spider veins can affect people of all ages, most often they are between 18 and 35 years of age. The second peak of telangiectasia occurs between 50 and 60 years of age,
- pregnancy – it is a very common cause of telangiectasia. It is related to the increase in progesterone during pregnancy, which directly weakens the walls of the veins. The veins are also stretched as a result of an increase in circulating blood volume, which causes blood to accumulate inside the lumen of the vessels. Spider veins or varicose veins arising during pregnancy may disappear spontaneously (completely or partially) several months after childbirth,
- profession / lifestyle – people who work in a sitting position, e.g. office worker / driver or in a standing position (e.g. salesman, doctor), are exposed to the occurrence of spider veins.
External factors that increase the risk of spider veins:
- frequent use of the solarium,
- prolonged exposure to the sun,
- high air humidity,
- wind,
- temperature fluctuations,
- the use of topical steroids (especially around the face and neckline),
- use of biostimulating lasers.
Telangiectasia – division
Clinically distinguished by:
1. Primary telangiectasias – their occurrence is associated with inherited diseases of the skin and internal organs.
2. Acquired telangiectasia – they are related to the influence of various external factors, skin ailments and other general diseases.
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Symptoms of telangiectasia
The lesions are located on the lower and upper limbs, on the face and other parts of the body (much less frequently). The patient has dilated, red-colored fluff-like lesions, which are rarely accepted by the patient due to their unsightly appearance. Sometimes they cause slight pain. They can appear as single, limited lesions or diffuse, occupying large areas of the skin. Larger ones with a diameter> 1 mm are perceptible to the touch.
Telangiectasia should be differentiated from neovascular changes and venulectasias.
Treatment consists primarily in improving the skin in terms of aesthetics, because women very often feel embarrassed due to spider veins. Removal of telangiectasia is based on the closure of a blood vessel by breaking its continuity.
The choice of method obviously depends on the extent of the spider veins and their location. The quality of the device and the experience of the specialist performing the procedure also play an important role.
The vessel can be closed by means of:
- sclerotherapy (blood vessels on the legs) – a method consisting in injecting a sclerosing agent into a blood vessel, which causes the lumen of the vessel to overgrow;
- electrocoagulation – it is a non-invasive method that involves the coagulation of tissues using high-frequency current. With the help of a special electrode, each vessel is touched in turn, causing it to close. This method is used in removing blood vessels located on the face. The healing process does not take long and depends on the sensitivity of the patient’s skin,
- laser therapy – the use of a laser causes thermal coagulation of the vessels. Among other things, an argon laser and the latest dye laser are used. After the procedure, blue spots appear on the patient’s skin that last up to ten days,
- cryochiructure – nitrous oxide or liquid nitrogen is used. This procedure is performed in people with contraindications to electrocoagulation,
- iontophoresis – this method uses direct current to remove blood vessels and prevents the expansion of blood vessels,
- electrolysis – causes tissue destruction by direct current,
- thermolysis – thermal destruction of tissues,
- electroplating – cuts the protein with direct current,
- physiotherapy treatments: Solux lamp with blue filter, iontophoresis, lymphatic drainage.
The prognosis of the ailments is good because single telangiectasias are only an aesthetic defect.
It is important to mention the contraindications for the above procedures:
- pregnancy,
- breast-feeding,
- epilepsy,
- diabetes (decompensated),
- bielactwo,
- sensitivity to light,
- having a pacemaker,
- psoriasis in a developed form,
- taking preparations that should not be exposed to radiation,
- pigmented pre-neoplastic and neoplastic changes,
- problems with proper blood clotting,
- the use of drugs that reduce blood clotting,
- having metal implants in the areas to be treated,
- subjecting to chemical peeling within the last three months.
- Protect the skin against UV rays – sun tanning beds. Before going out in the sun, remember to use creams with a UVA and UVB filter.
- Use barrier creams in the period of cold and dampness.
- Try not to overheat the skin of the face, e.g. when you are in a sauna.
- Invest in good cosmetics designed for vascular skin, especially those that constrict blood vessels.
- In the prevention of vascular skin, preparations that strengthen the walls of blood vessels are used.
- Avoid wearing high-heeled shoes with narrow toes.
THE MOST IMPORTANT: Don’t ignore telangiectasia! It should be remembered that dilated blood vessels can be more than just a cosmetic defect. They often point to dangerous changes in the venous system. Therefore, all people with spider veins should perform an ultrasound examination of the veins.
Lit.: [1] Ramelet A.A., Monti M.: Phlebology The guide. Elsevier 1999. [2] Bergan J.J.: The vein book. Elsevier 2007.
Source: A. Kaszuba, Z. Adamski: “Lexicon of dermatology”; XNUMXst edition, Czelej Publishing House