What is Telangiectasia?
Telangiectasia is a condition characterized by a permanent dilation of small blood vessels on the skin. It is manifested through red lines or patterns that usually develop on the skin in the areas of the lips, eyes, fingers, nose and the oral cavity. The onset may be non-specific but can be associated with the existing underlying condition. Telangiectasia is medically non-specific but can be painful and may cause undue discomfort and causes an unattractive appearance which can affect the quality of life. Telangiectasia is also among the component of CREST which is a variation of Scleroderma. It is generally non-life threatening condition except for some form of Telangiectasia.
CREST is an acronym for "Calcinosis, Raynaud’s syndrome, Esophageal dysmotility, Sclerodactyly and Telangiectasia" which are the five main features of the syndrome. It is a collection of symptoms manifesting limited cutaneous systemic scleroderma.
The veins are blood vessels that are responsible for transporting blood low in oxygen from the various organs of the body towards the heart. The veins carry the waste product or carbon dioxide released by different organs of the body where it is transported towards the heart. The waste products are then carried out from the heart to the lungs for release and reload of more oxygen to be distributed back to the different organs of the body through the arteries.
Telangiectasia is also referred to as "spider veins". It is a common occurrence and prevalent among older people and women of childbearing age although it can also affect people in different age group with peak onset during the 4th to 5th decade of life. Men can also get affected with Telangiectasia except that it is more common in women. Telangiectasia also has no racial predilection and is therefore can occur in all people from all over the world.
Telangiectasia can occur in any part of the body although it is commonly seen on the face, nose, cheeks and the chin. Spider web can also develop in the areas of the leg particularly on the upper leg and areas below the knees. The dilation of the small blood vessels covers about 0.5mm to 1mm in diameter with pinkish to reddish discoloration with linear appearance that is symmetrically distributed in the skin. Telangiectasia on the other hand may also occur in the vital organs of the body including the brain and which can be potentially life-threatening as it may cause massive bleeding when Telangiectasia ruptures or breaks causing internal bleeding.
No physical symptoms generally occur with the onset of Telangiectasia. The onset however may cause discomfort and more commonly a concern with regards to cosmetic appearance. The signs and symptoms on the other may include the following:
- Dull ache over the affected area.
- Sensation of pressure buildup over the affected area.
- Itchiness over the area of Telangiectasia.
- Apparent onset of linear marks that are reddish and symmetrically distributed on the skin surface.
The symptoms of Telangiectasia in Hereditary Hemorrhagic Telangiectasia on the other hand differ from the generalized Telangiectasia and the symptoms include the following:
- Bleeding of the nose as a result of the development of mucocutaneous lesion in the nasal mucosa, lips and tongue.
- The lesions have a spider-like appearance that have sharply demarcated macules with reddish to purplish discoloration.
- The spider-like lesions can also occur in the conjunctiva of the eyes, brain, gastrointestinal tract, liver, bronchi, bladder, vagina and the upper respiratory tract.
- Telangiectasia in the bronchi may result to a symptom of shortness of breath.
- The development of Telangiectasia in the central nervous system may exhibit seizure or epilepsy or may also result to stroke and cerebral abscess.
- The stool may appear with reddish or black stool when Telangiectasia develop in the gastrointestinal tract.
The exact cause of Telangiectasia remains obscure while the factors influencing the incidence have been divided into two categories according to the manner Telangiectasia was acquired.
Congenital causes of Telangiectasia are those acquired since birth, although it does not necessarily mean that the manifestation of the condition occurs right after delivery. Possible causes of Telangiectasia under congenital include the following:
- Ataxia Telangiectasia also referred to as Louis-Bar syndrome is an inherited disorder affecting the nervous system and the immune system including the other system of the body. The disorder is characterized by a progressive difficulty in coordinating movement. Telangiectasia occurring in the sclera of the eyes and sun exposed areas of the skin is characteristic of this syndrome.
- Klippel-Trenaunay-Weber syndrome is an uncommon congenital condition characterized by port-wine stain, vessel and lymphatic malformations and hypertrophy of the soft tissues of the affected limb. This rare congenital syndrome is believed to be a risk factor influencing the onset of Telangiectasia as a result of failure in the formation of the blood vessels or the lymph vessels.
Acquired causes of Telangiectasia may or may not be related to venous hypertension and the etiology may include the following:
- Exposure to sun and cold that can bring damage to the small blood vessels.
- Any form of trauma to the skin such as surgical incision, cuts and contusions.
- Exposure to either or both of radiation therapy and chemotherapy.
Predisposing factors for Telangiectasia include the following:
- Age advancement as the condition usually occurs during the 5th to 6th decade of life.
- Pregnancy in Telangiectasia is being associated with the weakening of the vein walls resulting from the circulating hormones and the increasing blood volumes that can distend the veins.
- Occupational factor or activities such as those that requires long periods of standing or sitting is a risk factor for Telangiectasia as a result of vein distention from continuous pressing subjected to the closed valves.
The treatment of Telangiectasia is aimed at improving the appearance of the skin marked by the development of spider-like lesions. The prognosis in improving the appearance is generally good and treatable.
Sclerotherapy is the most preferred intervention for improving the appearance of the skin affected with Telangiectasia. The aim is to damage the inner lining of the blood vessel until it thickens and collapsed.
Laser ablation is a procedure that targets the dilated vessels and eventually seals it. This procedure is less painful with a short recovery period.
Surgical removal of dilated vessels on the other hand is generally painful and requires a long period for recovery.