Telangiectasia refers to visibly dilated small blood vessels located in the superficial layers of the skin or mucous membranes. These lesions are usually red, purple or bluish and may appear as fine lines, clusters or star-shaped patterns. While often harmless and purely cosmetic, telangiectasias can sometimes indicate an underlying systemic condition such as hereditary hemorrhagic telangiectasia, systemic sclerosis or liver disease. Recognizing their appearance and context is therefore essential for both clinicians and patients. 

Telangiectasia is a descriptive vascular phenomenon that can occur as a result of aging, chronic environmental exposures or systemic illness. These dilated vessels, usually less than 1 mm in diameter, are found in the superficial dermis or mucosa. The lesions are often asymptomatic but may cause cosmetic concern. Some forms are patterned such as spider angiomas with a central arteriole and radiating capillaries, while others are linear or mat-like. 

Common sites of telangiectasia 

• Face (cheeks, nose, around the eyes) 

• Lips 

• Hands and fingers 

• Oral and nasal mucosa 

• Legs especially in chronic venous disease 

Appearance of telangiectasia 

• Fine, thread-like lines or clusters 

• Linear, star-shaped or mat-like configurations 

• Blanch on pressure due to vascular origin 

Telangiectasia can develop for a variety of reasons and the causes are generally grouped into three categories. Some cases are congenital, linked to genetic conditions such as hereditary hemorrhagic telangiectasia or ataxia-telangiectasia. Others are acquired later in life due to environmental exposures, systemic diseases or normal aging. In addition, certain medications can trigger the development of these dilated blood vessels. 

Congenital causes 

• Hereditary hemorrhagic telangiectasia (HHT): Genetic disorder causing mucocutaneous telangiectasias and arteriovenous malformations 

• Ataxia-telangiectasia: Rare neurodegenerative disorder with immunodeficiency and conjunctival telangiectasias 

Acquired causes 

• Chronic sun exposure damaging dermal tissue 

• Normal aging with weakening vessel support 

• Chronic venous insufficiency leading to leg telangiectasias 

• Rosacea often presenting with facial lesions 

• Systemic sclerosis with mat-like vascular clusters 

• Liver disease causing spider angiomas 

• Localized damage from radiation therapy 

Medication-related causes 

• Long-term topical corticosteroids especially on thin skin 

• Estrogen therapy 

• Certain chemotherapy agents 

Telangiectasias form when the small blood vessels in the skin or mucous membranes lose their normal support and elasticity, leading to permanent dilation. This process may result from aging, environmental damage, genetic predisposition or systemic disease. In many cases, multiple factors work together to weaken vascular walls or increase pressure within the vessels. Over time, these changes create visible thread-like or clustered vascular patterns that characterize telangiectasia. 

• Loss of vessel wall integrity: Aging, sun damage or radiation can weaken vessel walls 

• Increased vascular pressure: Seen in venous insufficiency, obesity or prolonged standing 

• Hormonal influences: Estrogen promotes vessel dilation, explaining higher prevalence during pregnancy, with oral contraceptives or in liver disease 

• Abnormal angiogenesis: Genetic mutations in HHT disrupt vessel repair, leading to fragile dilated vessels 

• Chronic tissue injury: Ultraviolet exposure and prior radiation therapy can damage dermal vasculature 

Time course of development 

• Congenital forms: Often appear in childhood or adolescence with increasing visibility over time 

• Acquired forms: Develop gradually, often after years of sun exposure, venous disease or hormonal changes 

• Hormonal-related: May develop over weeks to months in pregnancy or liver dysfunction 

Telangiectasias are most often recognized as visual findings on the skin or mucous membranes. While they are usually harmless, their appearance can sometimes point to underlying systemic disease. The presence of additional symptoms depends on the specific cause or associated condition. For this reason, careful observation and assessment are important when telangiectasias are identified. 

Visual features 

• Fine red, blue or purple lines on skin or mucosa 

• Spider-like lesions with central arteriole 

• Mat-like vascular clusters 

Systemic associations 

• HHT: Nosebleeds, gastrointestinal bleeding, anemia, arteriovenous malformations 

• Ataxia-telangiectasia: Gait instability, recurrent infections 

• Systemic sclerosis: Skin thickening, Raynaud’s phenomenon, gastrointestinal symptoms 

• Cirrhosis: Jaundice, ascites, gynecomastia 

Symptom-related concerns 

• Cosmetic distress, common in facial or visible sites 

• Rare bleeding episodes especially in mucosal sites or HHT 

• Leg heaviness or aching if associated with venous insufficiency 

Diagnosis of telangiectasia begins with a careful clinical examination and review of the patient’s history. In most cases, the dilated blood vessels can be recognized visually but further testing may be needed to uncover any underlying systemic condition. Doctors often evaluate lesion distribution, associated symptoms and possible risk factors. When systemic disease is suspected, targeted investigations are ordered to confirm the diagnosis. 

Clinical evaluation 

• Visual inspection of color, distribution and pattern 

• Blanching test confirming vascular nature 

Dermatoscopy 

• Helps differentiate telangiectasia from pigmented or malignant lesions 

• Reveals fine linear or dotted vessels 

Patient history 

• Family history of HHT or ataxia-telangiectasia 

• Risk factors such as sun exposure, venous disease, steroid use or radiation 

Additional investigations for systemic disease 

• HHT: Genetic testing, CT/MRI for AVMs, echocardiography with bubble study 

• Liver disease: Liver function tests, ultrasound, elastography 

• Systemic sclerosis: Autoimmune serology including ANA, anti-centromere, anti-Scl-70 antibodies 

• Chronic venous disease: Duplex Doppler ultrasound to assess venous reflux 

Management depends on cause, severity and patient concern. 

General measures 

• Regular sunscreen use and sun protection 

• Avoidance of long-term topical steroids 

• Compression stockings for lower limb telangiectasia from venous disease 

Cosmetic and localized treatments 

• Laser therapy: Pulsed dye laser (PDL) for facial lesions, Nd:YAG for deeper or leg vessels, IPL for diffuse lesions 

• Sclerotherapy: Effective for leg telangiectasias; involves injection of sclerosing agent 

• Electrosurgery: Suitable for small, isolated lesions 

Systemic disease management 

• HHT: Multidisciplinary care with screening for AVMs and possible interventions 

• Systemic sclerosis: Immunosuppressive therapy to limit progression 

• Liver disease: Managing hepatic dysfunction may reduce spider angiomas 

Preventive measures can reduce risk or slow progression: 

• Limit sun exposure, use sunscreen and protective clothing 

• Minimize corticosteroid use on sensitive skin 

• Manage risk factors such as obesity and prolonged standing 

Telangiectasia is a visible manifestation of dilated small blood vessels that may be purely cosmetic or a clue to underlying systemic disease. Although many cases are benign, their presence can sometimes signal serious conditions making clinical evaluation important. Effective treatment ranges from cosmetic interventions to targeted therapies for systemic disease. Preventive steps including sun protection and managing risk factors are also essential in reducing progression and improving patient outcomes. 

1. Guttmacher AE, Marchuk DA, White RI. Hereditary hemorrhagic telangiectasia. N Engl J Med. 1995;333(14):918-924. 

2. O’Donnell TF, Iafrati MD. The management of telangiectasias and varicose veins of the lower extremities. J Vasc Surg Venous Lymphat Disord. 2014;2(4):437-445. 

3. Hofer A, Cerroni L, Kerl H, Wolf P. Treatment of facial telangiectasias with pulsed dye laser. Arch Dermatol. 2000;136(7):805-808. 

4. Buechner SA. Rosacea: an update. Dermatology. 2005;210(2):100-108.