U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

Cover of StatPearls

StatPearls [Internet].

Show details

Spider Angioma

; .

Author Information and Affiliations

Last Update: July 17, 2023.

Continuing Education Activity

Spider angioma, also known as spider naevus or spider telangiectasia, is a vascular lesion characterized by anomalous dilatation of end vasculature found just beneath the skin surface. The lesion contains a central, red spot and reddish extensions which radiate outward like a spider's web. They may appear as multiple or solitary lesions. A spider angioma has 3 features: a body, legs, and surrounding erythema. The body appears as a 1 to 10 mm central arteriole visible as a punctum or eminence. It is typically painless, resembles a spider's body), and is surrounded by attenuated capillaries radiating in a spider-legged fashion, decreasing in size toward the margins. This activity reviews the evaluation and treatment of spider angiomas and the role of the interprofessional team in evaluating and treating this condition.


  • Describe the characteristic features of spider angiomas.
  • Summarize the common level of pain associated with a spider angioma.
  • Outline the treatment options available for a spider angioma.
  • Explain the importance of collaboration and communication among the medical team to ensure provide the best management of spider angiomas.
Access free multiple choice questions on this topic.


Spider angioma, also known as spider naevus or spider telangiectasia, is a vascular lesion characterized by anomalous dilatation of end vasculature found just beneath the skin surface. The lesion contains a central, red spot and reddish extensions which radiate outward like a spider's web. They may appear as multiple or solitary lesions. A spider angioma has 3 features: a body, legs, and surrounding erythema. The body appears as a 1 to 10 mm central arteriole visible as a punctum or eminence. It is typically painless, resembles a spider's body), and is surrounded by attenuated capillaries radiating in a spider-legged fashion, decreasing in size toward the margins.[1][2][3]


Spider angiomas are usually benign but often can be suggestive of an underlying systemic disease such as cirrhosis, rheumatoid arthritis, or thyrotoxicosis. Solitary spider angiomas are seen in 15% of young adults who usually have fewer than 3 lesions. The lesions also can appear in other physiologic conditions like pregnancy or severe malnutrition. Multiple spider angiomas are characteristic of chronic liver disease with a specificity of 95%.[4]


Prevalence of spider angiomas is highest among patients with cirrhosis, alcoholic hepatitis, and hepatopulmonary syndrome. Spider nevi correspond with a higher risk of mortality among patients with the alcoholic liver disease. They also suggest a high likelihood of esophageal varices and are indicative of the extent of hepatic fibrosis. The reported prevalence of spider angiomas in cirrhosis is 33%. In one study, 38% of healthy children had at least single spider telangiectasia. They are also visible in about 60% of pregnant women. Physiological spider angiomas in younger adults usually disappear as the age advances, although in few, it may take several years to disappear completely. In women who take oral contraceptives and present with lesions, they may resolve after the patient discontinues the hormonal preparations. If spider angiomas are associated with pregnancy, they will disappear after delivery of the baby. There is no racial predilection for spider angiomas, but lesions are more apparent in light-skinned patients. Spider angiomas are more common in women than in men, and this is thought to be due to the role of steroid hormones in their formation.


Spider naevus is dilation of preexisting central arterioles from which numerous thin-walled capillary branches radiate like spider legs, carrying away freely flowing blood. They form due to the failure of the sphincteric muscle surrounding a cutaneous arteriole leading to dilatation of central arteriole. The exact cause of spider angioma is not known. For decades, there have been many hypotheses of possible mechanisms that lead to the arteriolar vasodilation. Important among those are direct vasodilatory effects of alcohol, substance P, hyperestrogenism, and inadequate hepatic metabolism of steroid hormones. Angiogenesis as a possible mechanism in the pathogenesis of spider nevi has been proposed due to elevated serum vascular growth factors, such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) levels in patients with liver cirrhosis. Sex hormone imbalance predominantly hyperestrogenism has also been implicated for the development spider naevi. This is also suggested by the occurrence of spider angioma in individuals with a hyperestrogenic state, like pregnancy.[5][6]

History and Physical

Spider angiomas are characteristically found on the face, neck, upper chest, and arms in adults, corresponding to the distribution of superior vena cava. In children, lesions are common on the upper extremities. They may also be present on the backs of the hands and fingers. However, it must be emphasized that spider angiomas can also be seen in locations other than the skin, such as the mucosa of the oral cavity and gastrointestinal (GI) tract. Its characteristic appearance diagnoses spider angioma. Large spider angiomas may be pulsatile with blood flow toward the periphery secondary to the local increase in arterial blood supply. Bleeding from these lesions is unusual unless picked or scratched. Skin temperature over a spider nevus is higher than surrounding skin. The blood pressure measures 50 to 70 mm Hg in these small arterioles.

The direction of blood flow can be illustrated by applying pressure over the body of spiders with a glass slide (diascopy), leading to pallor with refilling following the release of pressure. No other angiomas show this phenomenon. Due to the varying sizes of spider angioma and for the ease of description, they can be graded from grade 1+ (readily recognizable containing a body, legs, and surrounding erythema) to grade 4+ (visible pulsations with a hand lens, and raised central punctum with many obvious “spider legs” radiating from it). Pregnant patients may present with numerous spider nevi which are harmless and usually resolve after childbirth. Patients with the chronic liver disease will typically have symptoms like jaundice, fluid retention, confusion, and on examination, shifting dullness, icterus, findings related to cause of cirrhosis, and stigmata of liver cell failure.


Solitary spider nevus in otherwise healthy individuals or pregnant women does not warrant further workup. A detailed history and focused physical exam can help to attribute multiple spider angioma to liver disease. As a general rule, number and size of spider angioma correlate with the severity of liver disease. In some occasions, history and exam might not point towards nevi and can lead to concerns of skin malignancy, such as basal cell carcinoma. A skin biopsy will be useful in these situations to exclude skin cancer or other conditions.[7][8][9][10]

Treatment / Management

Treatment of spider nevi is dependant on the cause of intra-arteriolar vasodilation. Patients with an underlying systemic disease like cirrhosis should be managed as the standard of care. However, when spider nevi are present, these patients may already have advanced liver disease.

Rarely, fine-needle electrocautery, 585 nm pulsed, dye laser, 532 nm KTP (potassium-titanyl-phosphate) laser, or electro desiccation have been used to clear spider angioma for cosmetic concerns. The results of the procedure are generally good except for the small risk of the scar. Spider angiomas can recur after treatment. Spider nevi in healthy individuals usually disappear in a few years, in pregnancy following childbirth and those related to oral contraceptive pills after discontinuation of medication. Cirrhotic patients note the disappearance of nevi following liver transplantation.

Differential Diagnosis

  • Acneiform Eruptions
  • Basal Cell Carcinoma
  • Cherry Hemangioma
  • Coastal Fringe
  • Essential telangiectasia
  • Fabry disease
  • Hereditary hemorrhagic telangiectasia
  • Insect Bites
  • Lobular capillary hemangioma
  • Osler-Weber-Rendu Syndrome
  • Rosacea
  • Scleroderma
  • Unilateral Nevoid Telangiectasia

Pearls and Other Issues

Multiple spider nevi usually indicate the presence of progressive hepatic fibrosis and advanced liver disease. Rarely, spider nevi can be a disguised basal cell carcinoma and may warrant a biopsy. Treatment of underlying cause usually leads to the disappearance of spider nevi. Cosmetic surgery may be attempted in specific circumstances.

Enhancing Healthcare Team Outcomes

Spider nevi may be encountered by the primary care provider or nurse practitioner. It is important to know that spider nevi are benign lesions and no treatment is generally required, except for cosmesis. There are several treatments available to treat spider nevi but with all of them, scarring and recurrence is a problem. In many cases, spider nevi regress spontaneously. The prognosis for patients with spider nevi is generally excellent unless they have underlying end-stage liver disease. (Level V)

Review Questions


Samant H, Kothadia JP. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 17, 2023. Spider Angioma. [PubMed: 29939595]
Gonzalez Ballerga E, Pozo MO, Rubatto Birri PN, Kanoore Edul VS, Sorda JA, Daruich J, Dubin A. Sublingual microcirculatory alterations in cirrhotic patients. Microcirculation. 2018 May;25(4):e12448. [PubMed: 29527776]
Singh S, Sahoo AK, Ramam M, Bhari N. Mucocutaneous spider angiomas in an adolescent with chronic liver disease. Arch Dis Child. 2018 Dec;103(12):1145. [PubMed: 29298760]
Yigider AP, Kayhan FT, Yigit O, Kavak A, Cingi C. Skin diseases of the nose. Am J Rhinol Allergy. 2016 May;30(3):83-90. [PubMed: 27216341]
Yalcin K, Ekin N, Atay A. Unusual presentations of spider angiomas. Liver Int. 2013 Mar;33(3):487. [PubMed: 23121469]
Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM. Does this patient with liver disease have cirrhosis? JAMA. 2012 Feb 22;307(8):832-842. [PubMed: 22357834]
Yang B, Li L, Zhang LX, Sun YJ, Ma L. Clinical Characteristics and Treatment Options of Infantile Vascular Anomalies. Medicine (Baltimore). 2015 Oct;94(40):e1717. [PMC free article: PMC4616746] [PubMed: 26448027]
Becher GL, Cameron H, Moseley H. Treatment of superficial vascular lesions with the KTP 532-nm laser: experience with 647 patients. Lasers Med Sci. 2014 Jan;29(1):267-71. [PubMed: 24401943]
Silvério Ade O, Guimarães DC, Elias LF, Milanez EO, Naves S. Are the spider angiomas skin markers of hepatopulmonary syndrome? Arq Gastroenterol. 2013 Jul-Sep;50(3):175-9. [PubMed: 24322187]
Beard MP, Millington GW. Recent developments in the specific dermatoses of pregnancy. Clin Exp Dermatol. 2012 Jan;37(1):1-4; quiz 5. [PubMed: 22007708]

Disclosure: Hrishikesh Samant declares no relevant financial relationships with ineligible companies.

Disclosure: Jiten Kothadia declares no relevant financial relationships with ineligible companies.

Copyright © 2024, StatPearls Publishing LLC.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Bookshelf ID: NBK507818PMID: 29939595


  • PubReader
  • Print View
  • Cite this Page

Related information

  • PMC
    PubMed Central citations
  • PubMed
    Links to PubMed

Similar articles in PubMed

See reviews...See all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...