Small, dilated blood vessels visible on the skin or mucous membranes, often appearing as fine red or purple lines (commonly called "spider veins").
Usually harmless and cosmetic, but can be key clues to underlying conditions. Telangiectases are one of the hallmark features in CREST syndrome and hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu), and in some cases they can bleed (e.g., recurrent nosebleeds or GI bleeding in HHT).
On exam they look like thin, red superficial vessels that blanch with pressure (blood is within dilated vessels). Commonly seen on the face (cheeks, nose) in sun-damaged skin or rosacea, and on the legs as spider veins (often from venous backpressure).
Consider context: telangiectases on the lips, tongue, and fingertips with frequent nosebleeds suggests HHT; telangiectases on the face and hands with sclerodactyly and calcinosis suggests CREST (limited scleroderma).
Can also appear after chronic radiation exposure or long-term topical steroid use (due to skin thinning), and become more numerous with age.
Differentiate telangiectasia from a bleeding rash: press on it (diascopy) – a telangiectasia will blanch (fade) when pressed, whereas a petechial rash (extravasated blood) remains red.
If you see multiple telangiectases, look for other signs of an associated disorder: e.g., check for epistaxis, AVMs, or family history (HHT); or for skin tightening, calcinosis, Raynaud phenomenon (CREST).
Management depends on cause: if isolated and bothersome, dermatologists can treat facial telangiectases with laser therapy or leg spider veins with sclerotherapy. If part of a syndrome, address the underlying disease (control rosacea, treat liver disease, etc., and in HHT manage bleeding lesions).
Benign small red papules (capillary hemangiomas) common in adults; do not blanch fully when pressed.
Petechiae/Purpura
Non-blanching red spots due to bleeding under skin, typically from thrombocytopenia or vasculitis (not dilated vessels).
For isolated cosmetic telangiectases: laser therapy (for facial lesions) or sclerotherapy injections (for leg veins) can remove them.
If associated with a disease, treat the underlying condition to reduce new lesions (e.g., manage rosacea or liver disease). In syndromes like HHT, local measures (laser/cautery) are used to control bleeding telangiectasias as needed.
Mnemonic: CREST syndrome — *T* for Telangiectasia (along with Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly).
Telangiectasias blanch under pressure (unlike cherry angiomas or purpura), which is a useful clue on exams.
Telangiectasia plus frequent epistaxis or GI bleeding → suspect hereditary hemorrhagic telangiectasia (risk of serious AVM bleeding).
Telangiectasia in a child with ataxia and recurrent infections → consider ataxia-telangiectasia (DNA repair disorder with immunodeficiency).
Multiple telangiectases with sclerodactyly and calcinosis → likely CREST syndrome (indicates systemic sclerosis, needs workup for organ involvement).
See a red lesion → blanch test (diascopy) to confirm telangiectasia (will blanch) versus purpura (no blanch).
If telangiectasia confirmed, assess extent: isolated vs widespread. Check for any syndromic features (nosebleeds, organ AVMs, skin changes, etc.).
Single/few lesions with no other findings → likely idiopathic or sun-related; can manage cosmetically if desired.
Multiple lesions + systemic features → evaluate for underlying syndrome (genetic testing for HHT or AT, autoimmune workup for CREST).
Address underlying disease and provide specific treatments (e.g., laser ablation for bleeding nasal telangiectases in HHT, vascular laser for cosmetic improvement in scleroderma).
A young adult with recurrent nosebleeds and iron deficiency anemia has multiple pinpoint red lesions on his lips and oral mucosa that blanch with pressure → Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome).
A middle-aged woman with long-standing Raynaud phenomenon and tight, shiny skin on her fingers develops numerous red spots on her face and hands → CREST syndrome (limited cutaneous systemic sclerosis).
Case 1
A 35‑year‑old man reports lifelong recurrent nosebleeds and recent iron deficiency anemia due to GI bleeding.
Case 2
A 52‑year‑old woman with limited cutaneous scleroderma presents with new red spots on her face and hands.
Lips with multiple telangiectasias (hereditary hemorrhagic telangiectasia).
