Forgive my poor depiction of spider veins on this man in the picture, I ain’t no Picasso. Spider nevi (or spider angioma or telangiectasis) are blanchable, asymptomatic red spots on the skin typically associated with liver disease, thought to be due to estrogen and vascoactive cytokines . They can present in normal situations too such as young people (usually 3 or less) and pregnancy and in women taking OC pills. But the presence of multiple such lesions typically implies liver disease in 95 times out of 100, usually cirrhosis.
A small study back in 1988 named “Cutaneous vascular spiders in cirrhotic patients: correlation with hemorrhage from esophageal varices” evaluated 92 male cirrhosis patients who underwent screening EGDs and correlated variceal findings to the presence of spider nevi.
What this little study found :
– Around 90% patients had spider nevi while 91% had esophageal varices (indirect correlation)
– Risk of variceal bleeds was around 3 times higher if spider nevi were also present
– The Higher the number of nevi (> 20), higher the risk of bleed
– The Larger the nevi (> 15mm), higher the risk of bleed
Of course, this is a small and very old study with limitations, but interesting and it suggests a common basis of pathogenesis of both varices and spider nevi. Makes me wonder if a prophylactic use of a beta-blocker (if not contraindicated) in such patients with large numbers of spider nevi is justified until they get an EGD, but it’s a thought which will need to be a larger study to prove benefit. Maybe if one of you need a clinical project / study, this could be one to corroborate!
💡 Presence of numerous and large spider nevi can indicate a higher risk of esophageal varices and bleeds in liver disease, these patients should have a screening EGD sooner. Should we call spider nevi a ‘poor man’s EGD’? 😉
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