Nevus Araneus (Spider Nevus)

Nevus Araneus (Spider Nevus)

No Results

No Results


Nevus araneus, also known as spider angioma or spider nevus, is a common benign vascular lesion present in 10-15% of healthy adults and young children. [1, 2] They may appear as a solitary or multiple lesions. [2] In particular, when multiple lesions are present, liver disease, estrogen therapy, and thyrotoxicosis should be considered. The name stems from its physical appearance, which is characterized by a central red arteriole, or punctum, representing the body of the spider, surrounded by a radial pattern of thin-walled capillaries, resembling legs (see the image below).

Nevus araneus lesions range in size from 1-10 mm in diameter. Compression of the central vessel with a slide (diascopy) results in blanching and temporary obliteration of the lesion, which is followed by rapid return of blood flow upon release. [1] Pulsations may occasionally be felt upon compression of the punctum. [3] In adults, these lesions are most frequently found on exposed areas of the body, such as the face, neck, upper trunk (above the nipple line), and arms. In children, the backs of the hands and fingers are commonly affected. [1, 3]

Vascular malformations can be classified into 6 categories: hamartomas, malformations, dilatations of preexisting vessels, hyperplasias, benign neoplasms, and malignant neoplasms. [3] Spider angiomas (nevus araneus) are not vascular proliferations; they occur as a result of the dilation of preexisting vessels. [1, 3]

While most lesions are unrelated to internal disease, spider angiomas (nevus araneus) have been associated with thyrotoxicosis, [4] and frequently occur in the presence of estrogen-excess states, such as pregnancy or during the use of oral contraceptives. Resolution of lesions in this context is common 6-9 months postpartum or after discontinuation of oral contraceptive medication. [5]

Spider angiomas (nevus araneus) are also associated with liver disease, liver failure, and cirrhosis. [6, 7, 8] In fact, the spider angioma is rumored to have received its name from barmaids in New York, who used the lesion as a marker of liver disease in their customers. [4] When associated with liver disease, spider angiomas may be numerous, large in size, [9] and appear in atypical locations [10] ; other findings may be present, including palmar erythema, muscle atrophy, gynecomastia, ascites, jaundice, splenomegaly, [4] leukonychia, onychomycosis, and longitudinal nail striations. [11] The number of lesions may be indicative of the extent of hepatic fibrosis. [8]

The exact etiology of the spider nevus (nevus araneus) is unclear. Estrogen-excess states such as pregnancy and liver disease have been associated with spider angiomas for many years. This hypothesis is partially based on the hormone’s dilating effects on endometrial spiral arterioles during pregnancy. [12] Additionally, other biologic substances, including vascular endothelial growth factor (VEGF), [13] basic fibroblastic growth factor (bFGF), [14] substance P, and endogenous vasodilators, [12] have been implicated in the pathogenesis of spider angioma (nevus araneus). One study demonstrated that although the ratio of estrogen to testosterone in the serum of cirrhotic patients did, in fact, vary inversely with liver function, the numbers never reached statistical significance. [12]

In the context of liver disease, spider nevi are found more commonly in alcoholic cirrhotics versus nonalcoholic cirrhotics, [15] as well as disease secondary to alcohol abuse versus that caused by viral hepatitis. [16]

Children with liver disease rarely have large numbers of spider angiomas. Although the finding of 5 or more spider angiomas is more common in persons with liver disease, many healthy children also have one or more of these lesions. [2]

United States

Young children and pregnant women most frequently exhibit spider angioma (nevus araneus) lesions. In pregnant women, palmar erythema may also be present. [5] Spider angiomas are common in otherwise healthy children and are present in 10-15% of healthy adults and young children. [1]


The frequency of spider angiomas (nevus araneus) is presumed to be similar to that in the United States.

No racial predilection is reported for spider angioma (nevus araneus), but lesions are more apparent in light-skinned patients.

Spider angiomas (nevus araneus) are more common in women than in men, although a definitive study documenting this is not available. Young children of both sexes and pregnant women frequently exhibit lesions. [2, 5]

One study demonstrated that 38% percent of healthy, school-aged children (ages 5-15 y) had at least one spider nevus (nevus araneus), while most had 1-4 lesions. The trend was an increasing number of lesions with increasing age. [2] Spider angiomas also are common in women of childbearing age in association with pregnancy or oral contraceptive use. [5]

Spider angiomas (nevus araneus) are asymptomatic benign lesions. When extensive, they may be associated with significant underlying internal pathology, such as liver disease. [6, 7, 8] Spider angiomas (nevus araneus) also may produce significant cosmetic concerns in some patients.

When not associated with underling pathology or pregnancy, spider angioma (nevus araneus) lesions may be permanent or may regress over a number of years. Recurrence is not uncommon after treatment. [17, 18, 19, 20, 21, 22, 23, 24]

Although a finding of 5 or more spider nevi is common in children with liver disease, this quantity can also be present in many healthy children. [2] In association with liver disease, lesions may resolve after liver transplantation. [6]

Spider nevi occurring in the context of pregnancy or oral contraceptive use may regress postpartum or after discontinuation of medicine. [5] They may also regress after death or in situations resulting in severe hypotension. [1]

Khasnis A, Gokula RM. Spider nevus. J Postgrad Med. 2002 Oct-Dec. 48(4):307-9. [Medline]. [Full Text].

Finn SM, Rowland M, Lawlor F, Kinsella W, Chan L, Byrne O, et al. The significance of cutaneous spider naevi in children. Arch Dis Child. 2006 Jul. 91(7):604-5. [Medline]. [Full Text].

Requena L, Sangueza OP. Cutaneous vascular anomalies. Part I. Hamartomas, malformations, and dilation of preexisting vessels. J Am Acad Dermatol. 1997 Oct. 37(4):523-49; quiz 549-52. [Medline]. [Full Text].

Graham-Brown RA. Hepatobiliary System and the Skin. Irwin Freedberg AE, Klaus Wolff, K Frank Austen, Lowell Goldsmith, Stephen Katz, Thomas Fitzpatric. Fitzpatrick’s Dermatology In General Medicine. Fifth. New York: McGraw-Hill; 1999. 1918.

Henry F, Quatresooz P, Valverde-Lopez JC, Piérard GE. Blood vessel changes during pregnancy: a review. Am J Clin Dermatol. 2006. 7(1):65-9. [Medline]. [Full Text].

Detry O, De Roover A. Images in clinical medicine. Spider angiomas. N Engl J Med. 2009 Jan 15. 360(3):280. [Medline]. [Full Text].

Udell JA, Wang CS, Tinmouth J, et al. Does this patient with liver disease have cirrhosis?. JAMA. 2012 Feb. 307(8):832-42. [Medline]. [Full Text].

Niederau C, Lange S, Frühauf M, Thiel A. Cutaneous signs of liver disease: value for prognosis of severe fibrosis and cirrhosis. Liver Int. 2008 May. 28(5):659-66. [Medline]. [Full Text].

Hane H, Yokota K, Kono M, Muro Y, Akiyama M. Extraordinarily large, giant spider angioma in an alcoholic cirrhotic patient. Int J Dermatol. 2014 Feb. 53(2):e119-21. [Medline].

Yalcin K, Ekin N, Atay A. Unusual presentations of spider angiomas. Liver Int. 2013 Mar. 33(3):487. [Medline].

Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol. 2010 Jun. 24(6):649-54. [Medline]. [Full Text].

Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, et al. Role of substance P in the pathogenesis of spider angiomas in patients with nonalcoholic liver cirrhosis. Am J Gastroenterol. 1999 Feb. 94(2):502-7. [Medline]. [Full Text].

Isner JM, Pieczek A, Schainfeld R, Blair R, Haley L, Asahara T, et al. Clinical evidence of angiogenesis after arterial gene transfer of phVEGF165 in patient with ischaemic limb. Lancet. 1996 Aug 10. 348(9024):370-4. [Medline]. [Full Text].

Li CP, Lee FY, Hwang SJ, Lu RH, Lee WP, Chao Y, et al. Spider angiomas in patients with liver cirrhosis: role of vascular endothelial growth factor and basic fibroblast growth factor. World J Gastroenterol. 2003 Dec. 9(12):2832-5. [Medline]. [Full Text].

Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, et al. Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function. Scand J Gastroenterol. 1999 May. 34(5):520-3. [Medline]. [Full Text].

Iino S. [Differentiation alcoholic liver cirrhosis from viral liver cirrhosis]. Nippon Rinsho. 1994 Jan. 52(1):174-80. [Medline].

Sivarajan V, Al Aissami M, Maclaren W, Mackay IR. Recurrence of spider naevi following treatment with 585 nm pulsed dye laser. J Plast Reconstr Aesthet Surg. 2007. 60(6):668-71. [Medline]. [Full Text].

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. [Medline]. [Full Text].

Bjerring P, Christiansen K, Troilius A. Intense pulsed light source for treatment of facial telangiectasias. J Cosmet Laser Ther. 2001 Dec. 3(4):169-73. [Medline]. [Full Text].

Kono T, Sakurai H, Groff WF, Chan HH, Takeuchi M, Yamaki T, et al. Comparison study of a traditional pulsed dye laser versus a long-pulsed dye laser in the treatment of early childhood hemangiomas. Lasers Surg Med. 2006 Feb. 38(2):112-5. [Medline]. [Full Text].

Michel JL. Treatment of hemangiomas with 595 nm pulsed dye laser dermobeam. Eur J Dermatol. 2003 Mar-Apr. 13(2):136-41. [Medline].

Tan E, Vinciullo C. Pulsed dye laser treatment of spider telangiectasia. Australas J Dermatol. 1997 Feb. 38(1):22-5. [Medline]. [Full Text].

Tan OT, Gilchrest BA. Laser therapy for selected cutaneous vascular lesions in the pediatric population: a review. Pediatrics. 1988 Oct. 82(4):652-62. [Medline]. [Full Text].

Woo SH, Ahn HH, Kim SN, Kye YC. Treatment of vascular skin lesions with the variable-pulse 595 nm pulsed dye laser. Dermatol Surg. 2006 Jan. 32(1):41-8. [Medline]. [Full Text].

Collyer J, Boone SL, White LE, Rademaker A, West DP, Anderson K. Comparison of treatment of cherry angiomata with pulsed-dye laser, potassium titanyl phosphate laser, and electrodesiccation: a randomized controlled trial. Arch Dermatol. 2010 Jan. 146(1):33-7. [Medline]. [Full Text].

Sarah Sweeney Pinney, MD Assistant Professor, Department of Dermatology, University of Texas Health Science Center at Houston, McGovern Medical School

Sarah Sweeney Pinney, MD is a member of the following medical societies: American Academy of Dermatology, Texas Dermatological Society, Texas Medical Association, Women’s Dermatologic Society

Disclosure: Nothing to disclose.

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, American Society of Dermatopathology, Association of Professors of Dermatology, Society for Investigative Dermatology, Texas Dermatological Society

Disclosure: Book royalties from Elsevier publishers.

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Mark Crowe, MD, to the development and writing of this article.

Nevus Araneus (Spider Nevus)

Research & References of Nevus Araneus (Spider Nevus)|A&C Accounting And Tax Services