IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 77 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
   Article in PDF (101 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed23501    
    Printed41    
    Emailed1    
    PDF Downloaded248    
    Comments [Add]    
    Cited by others 2    

Recommend this journal

 


 
LETTER TO EDITOR
Year : 2008  |  Volume : 74  |  Issue : 4  |  Page : 397-398

Spider nevi: A presenting feature of chronic liver disease


Department of Dermatology, Apollo Hospitals, Chennai, India

Correspondence Address:
Maya Vedamurthy
AB-76, I street, Annanagar, Chennai-600 040
India
Login to access the Email id


DOI: 10.4103/0378-6323.42921

PMID: 18797075

Get Permissions



How to cite this article:
Vedamurthy M, Vedamurthy A. Spider nevi: A presenting feature of chronic liver disease. Indian J Dermatol Venereol Leprol 2008;74:397-8

How to cite this URL:
Vedamurthy M, Vedamurthy A. Spider nevi: A presenting feature of chronic liver disease. Indian J Dermatol Venereol Leprol [serial online] 2008 [cited 2014 Dec 17];74:397-8. Available from: http://www.ijdvl.com/text.asp?2008/74/4/397/42921


Sir,

The vascular spider, arterial spider or spider angioma is the most classical vascular lesion that is sometimes a presenting sign of chronic liver disease. Spider telangietasia occur in up to 15% of normal individuals and may also be seen in pregnant women. The main vessel of the spider is an arteriole represented by a red point from which numerous, small, twisted vessels radiate. Application of pressure on the central arteriole with the head of a pin or a match stick causes blanching of the whole lesion. We report here a case with profusion of spider nevi predating the onset of liver disease.

A 36 year-old, non-alcoholic man presented to the Dermatology OPD for evaluation of multiple, eight months old, erythematous, asymptomatic macules distributed mainly over the front of the chest, with a few on the upper arm and back [Figure 1]. The rash was earlier diagnosed as an allergic reaction and was treated with antihistamines by a general physician. Six months after the patient presented to us, he developed jaundice and was investigated and found to have chronic liver disease.

Dermatological examination showed hundreds of erythematous macules 2-5 mm in size, mainly over the front of the chest, upper abdomen and a few on the upper arm and back [Figure 1]. The central body and the vessels radiating from it, could be seen clearly in a few lesions; mucous membranes were spared. There was no other dermatological evidence of chronic liver disease.

Hematological investigations revealed thrombocytopenia: 1,25,000 (Normal = 1,50,000-4,50,000); prothrombin time = 17 s (control: 13 s ) and activated partial thromboplastin time = 36 s (control: 26 s) were prolonged. Viral markers for hepatitis were all absent. Total estrogen level was 85.7 pg/mL (normal < 56 pg/mL) and the total testosterone level was 218 mg/dL (normal: 245-1836 mg/dL). Tests for antinuclear antibody and alpha fetoprotein were also negative. Liver function tests showed elevated bilirubin (total 4.3 mg/dL) and elevated enzyme levels (ALT: 93 IU/L, ALP: 328 IU/L) (expand abbreviations). Blood sugar and renal parameters were normal. An ultrasound of the whole abdomen showed a shrunken liver with a coarse and nodular echo texture, suggestive of chronic liver disease, splenomegaly and ascites. A liver biopsy was not done as the patient was unwilling to have it done. Based on the above findings, a diagnosis of cryptogenic cirrhosis was made.

Spider angioma or nevus araenus is a dilatation of preexisting vessels under several circumstatnces. [1] Common causes of spider nevi are listed in [Table 1].

Spider nevi are commonly distributed over the face, necklace area, forearms, hands and the upper part of chest, i.e., mainly over the region drained by the superior vena cava. [2] Vascular spiders have been attributed to excessive levels of estrogen because estrogens cause blood vessels to enlarge and dilate. [3] Serum estradiol and total testosterone levels are altered particularly in male patients with cirrhosis and spiders. Serum estradiol levels are increased and the total free testosterone level is reduced, thus leading to high estradiol/free testosterone ratios in male patients with spiders. Regression of spiders in patients with liver disease is possible with an improvement in the underlying condition although persistence of these spiders is more likely. [4]

Morphological studies and reconstruction methods demonstrated that spiders represent an arteriole and an organ with five separate parts:

  1. A cutaneous arterial net,
  2. A central spider arteriole,
  3. A subepidermal ampulla
  4. A star-shaped arrangement of afferent spider vessels, and
  5. Capillaries [5]


Awareness of the association of spider nevi with systemic illnesses is essential to determine the underlying pathology. This case is presented for two reasons: 1. As spider nevi can precede liver diseases, it would be advisable to screen the patients with spider nevi for liver disease as early detection could prove to be beneficial to the patient, 2. The presence of spider nevi is also considered to be one of the physical findings predicting the presence of esophageal or gastric varices in patients with advanced liver disease. [6] It could therefore be cost-effective to screen and identify a group of patients who would most benefit from endoscopic screening for varices.

 
  References Top

1.Robin AC Graham-Browne, Rathbone B, Marks J. The skin and disorders of the alimentary tract. In: Freedberg IM, Eisen AZ, Austen KF, Goldsmith LA, Katz SI et al, editors. Dermatology in internal medicine. 5 th ed. New York: McGrowHill; 1999. p. 1909-29.  Back to cited text no. 1    
2.Champion RH. Disorders of blood vessels. In: Champion RH, Burton JL, Ebling FJ, editors. Rook / Wilkinson / Ebling Textbook of Dermatology. 5 th ed. Oxford: Blackwell science Publishers; 1992. p. 1827-49.  Back to cited text no. 2    
3.Akiyama M, Inamoto N. Arteriovenous haemangioma in chronic liver disease - clinical and hisopathologic features of four cases. Br J Dermatol 2001;144:604-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Whiting DA, Kallmeyer JC, Simson IW. Widespread arterial spiders in a case of latent hepatitis with resolution after therapy. Br J Dermatol 1970;82:32-6.  Back to cited text no. 4  [PUBMED]  
5.Requena L, Sangueza OP. Cutaneous vascular anomalies Part I, Hamartomas, malformation and dilation of preexisting vessels. J Am Acad Dermatol 1997;37:523-49.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Zaman A, Hapke R, Flora K, Rosen HR. Bennerk in Factors predicting the presences of esophageal or gastric varices in patients with advanced liver disease. Am J Gasteroenterol 1999;95:3292-6.  Back to cited text no. 6    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]

This article has been cited by
1 Knowledge and attitude of dentists towards the use of botulinum toxin and dermal fillers in dentistry, Riyadh, Saudi Arabia
Eman M. Al Hamdan,Aamena M. Algheryafi,Fatimah J. Al-Ghareeb,Nahid Y. Ashri
Journal of Cosmetic and Laser Therapy. 2013; 15(1): 46
[Pubmed]
2 Spider nevi and chronic liver disease
Sharma, V., Aggarwal, S.
Indian Journal of Dermatology, Venereology and Leprology. 2009; 75(4): 403
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Medknow