What is telangiectasia?
Telangiectasia is the visibly widened blood vessels on the surface of the skin and mucous membranes. Most cases are not associated with any disease and apart from the cosmetic impact, it does not cause any long term problems. This is known as primary essential telangiectasia and is not due to any structural abnormality or disease process at the site. Bleeding is rare with primary essential telangiectasia.
There are certain forms of diseases and deformities of the blood vessels that can also be considered as primary telangiectasia. In some cases telangiectasia may arise with certain underlying disorders not specific to the blood vessels and it is then referred to as secondary telangiectasia. The disease process may cause the blood vessels to be very fragile and rupture easily. This causes bleeding under the skin and nosebleeds when the vessels in the nasal lining are broken.
Tiny Skin Blood Vessels
Function of the Skin Blood Vessels
The skin is highly vascularized meaning that it has an extensive network of blood vessels just under the outer layer of the skin. Apart from nourishing the skin with oxygen and nutrients, and removing wastes and carbon dioxide, blood vessels also play a role in thermoregulation. Here it can widen (dilate) to allow heat within the body to pass out into the body thereby preventing the internal temperature from rising to dangerous levels. Conversely, when the environment is cold or the internal temperature is lower than normal, these blood vessels become narrow (constrict) thereby reducing the blood flow to the skin. Therefore less heat from within the body is lost to the environment.
Arteries carry oxygen rich blood from the heart to the skin and veins take away blood laden with wastes and carbon dioxide away from the skin. However, these blood vessels are large and slowly become smaller to be able to lie closely to the skin tissue. Arteries become smaller arterioles and eventually blood from here drains into capillaries which lie within the skin tissue. These capillaries carrying oxygen-rich blood are continuous with capillaries taking away carbon dioxide laden blood. This blood is then drained into venules and then the veins which eventually return the blood to the heart.
Visible Blood Vessels on the Skin
Usually these capillaries are not visible since it is so small but the blood within it does play a role in the natural skin color of a person. It is also responsible for the change in skin color when the face is flushed or a person is blushing as well as in hot and cold weather. These capillaries are more easily visible on the mucus membranes like the lining inside the mouth or the whites of the eyes. Any irritation of these mucus membranes may make these capillaries more visible.
The odd visible capillary on the skin or the mucus membranes occurs at times and is often ignored. It is when it becomes permanently dilated and visible extensively on one site or throughout the body that it tends to prove a problem to a person. This is then known as telangiectasia. When it occurs as a network of visible capillaries, sometimes in resembling a web, it is also commonly referred to as a spider veins which is often seen with varicose veins in the leg.
Causes of Telangiectasia
Telangiectasia can be assessed according to the different types – primary (essential) or secondary. There appears to be greater risk of acquiring telangiectasia with one or more of the following factors :
- Advancing age
- Sedentary lifestyle
- Occupational hazards like standing for long periods
These risks are similar for conditions such as varicose veins indicating that it is more likely secondary telangiectasia. Although the condition can occur in any person, it is more commonly reported among Caucasians and light-skinned individuals probably because the skin complexion causes the vessels to be more easily seen. Women seem to be more frequently affected than men.
When telangiectasia occurs on its own without occurring secondary to another condition, then it is known as primary telangiectasia. The more common type is generalized essential telangiectasia which is harmless and not associated with any specific disorder of the capillaries. There is some evidence that it tends to run in families hinting at a possible genetic component. Furthermore telangiectasia on its own is not necessarily associated with varicose veins although it may arise in a person with this condition in which case it is secondary and not primary telangiectasia.
Other forms of primary, but not essential, telangiectasia include :
- angioma serpiginosum
- hereditary hemorrhagic telangiectasia
- spider naevi
Here the main problem lies with the blood vessels and the disease process is better understood.
Telangiectasia can occur with a host of conditions and is therefore termed secondary telangiectasia. This may be seen with :
- Venous insufficiency allowing for the pooling of blood especially in the limbs.
- Chronic inflammation at a site leading to increased blood flow that may permanently dilate the vessels.
- Certain substances (medication or other) which affects cardiovascular function and vessel structure.
Conditions where telangiectasia may be seen includes :
- Skin damage associated with sun exposure, chemicals, trauma.
- Long term topical corticosteroid (creams, ointments, lotions) use.
- Cancer treatment – radiation therapy and chemotherapy.
- Carcinoid syndrome.
Telangiectasia is evident by the network of red capillaries which are usually less than 0.2mm in diameter on the surface of the skin and mucous membranes. In addition, other symptoms may also be present such as :
- Red patches on the skin as dilated capillaries join.
- Tingling or numbness at the site.
- Paleness of the area when pressure is applied although blood flow restores soon after.
- Swelling at the affected area are usually as a result of the larger veins being compromised.
These concomitant symptoms are absent in the majority of generalized essential telangiectasia cases.
Telangiectasia is difficult to treat and with generalized essential telangiectasia, treatment is usually not necessary since it does not pose any problem beyond the cosmetic aspect. Many people therefore use cosmetic applications and tanning products to mask the capillaries. Conventional therapies used for larger leg vein problems such as sclerotherapy are not effective for telangiectasia and can worsen the condition. Electrosurgery and pulsed laser procedures may yield better results but is not completely effective for every site.