688                                        NEW GROWTHS

TELANGIECTASE

Synonyms.—Acquired vascular dilatations; Fr., Télangiéctasie.

Definition.—An enlargement, and probably new growth as well,
of the cutaneous capillaries, usually appearing during middle life, and
seated, for the most part, about the face.

Symptoms.—Dilatations or new formation of capillary vessels
are not at all uncommon in association with certain diseases, such as
acne rosacea, sometimes constituting the predominant or whole feature
of the case, and then usually designated rosacea. They are also seen in
association with angiokeratoma, xeroderma pigmentosum, some cases
of lupus, syphilis, lupus erythematosus, and similar disorders, in which
a prolonged, persistent hyperemia has existed. Telangiectases occur,
however, as an entirely independent affection, and most commonly about
the cheeks and alæ of nose, especially in individuals in middle and ad­
vanced life, and more particularly in those of plethoric habit, or in those
who naturally, or through diet, indigestion, and alcoholic stimulants (not
necessarily in excess), are subject to repeated facial flushings. They
are, probably, as an independent condition, most common or numerous
in the middle region of the cheek, which Hutchinson calls the flush-patch.
They are noted to be straight, zigzag, or tortuous, thread-like, red lines,
¹/₈ to ¹/₄ inch long, sometimes branching, in others being simply irregu­
larly crowded together. In some cases the dilatations may be much more
pronounced and slightly elevated. The condition may merely consist
of several such dilated capillaries, or they may be so numerous as to give
the face or part affected a distinctly rosaceous or flushed appearance,
due to some of the causes named, and occasionally, especially when about
the region of the nose, also to possible vascular obstruction due to in-
tranasal pressure (see Acne rosacea). In some cases, instead of distinctly
visible capillaries, it consists of a pinkish or reddish spot, which only on
close inspection discloses the fact that it is composed of numerous minute
capillaries. While its usual site is the face, exceptionally the develop­
ment is seen on other parts.¹

In some instances, and in infants and children, as well as in adults,
a not uncommon form, which is usually acquired, although it is occa­
sionally congenital, is that known as nævus araneus, or spider nævus
(also spider cancer). It consists of a pin-head­ to small pea-sized cen­
tral red spot or dot, flattened or slightly elevated or rounded, from which
radiate several or more red lines (capillaries), in a more or less straight,
irregular, or tortuous manner, extending one to several lines outward.
It presents, first, as a scarcely noticeable formation, and gradually be­
comes more conspicuous, but rarely attains more than small dimensions.
After lasting for some months or several years or longer such a blemish
sometimes spontaneously disappears; in other instances,—and in the large
majority,—however, persisting indefinitely, and may undergo further
enlargement, although seldom to a conspicuous extent. One or several
such formations may be present, and usually about the nose and the region

¹ Frick, Jour. Cutan. Dis., 1912, p. 334, reports a case practically involving the
entire surface, except below the knee, beginning on face and gradually extending.

TELANGIECTASIS                                      689

under the eyes. In a few rare exceptions, as in instances observed by
Mandelbaum¹ and Crocker,² they were quite numerous and more or less
general. Hillairet and Vidal³ have also each observed an instance
of more or less generalization. In the anomalous cases of multiple
vascular nævus recorded by Ullmann and Kopp, referred to under the
latter heading, the telangiectases, primarily of the striated, stellate, or
spider-nævus characters, underwent development, and changed into
small, vascular, tumor-like growths. Vidal's case, according to Kopp,
was partly of this character, bearing resemblance to his own.

The papillary varices, usually involving the capillary loops of a
number of contiguous papillæ, consist of pin-head­ to small pea-sized,
pale to dark or purplish red, flattened or rounded elevations. They
are commonly seen on the trunk, especially the upper part, and usually
in adult life, more particularly in those of middle age or advanced years,
and are suggestive of blood extravasation and the so-called blood-blister.
They are frequently moderately soft and somewhat compressible, with,
as a rule, no striæ peripherally, as in the spider nævus. Some of them,
on close inspection, are noted to be composed of a tuft of dilated capil­
laries, and which can be emptied by pressure; others are somewhat hard,
probably due to the conditions sometimes found, as described by Unna:
minute cavities or spaces inclosing blood capillaries; a number of minute
spaces filled with thrombi; and, in another instance, coagulation, the
thrombi consisting of fibrin and a few leukocytes; and also, in some of
them, in addition “the remaining space filled by closely packed red cor­
puscles," In such instance the blood-lesion is more solid and pressure
makes but little impression.

The varicosities and cavernous changes so commonly observed in
the veins (varicose veins) of the lower part of the leg, especially in those
of middle life and advancing years, and probably more frequently in
women who have borne many children, need scarcely be referred to here,
belonging more properly to the domain of surgery. It is to be looked
upon, however, in some instances as having an etiologic bearing upon
the production of eczema of these parts, and also to impaired tissue nu­
trition which results in ulceration—the well-known leg ulcer.

Treatment.—The treatment of the ordinarily observed telangi-

¹ Mandelbaum, Archiv, 1882, p. 213 (face, trunk, and limbs).

² Crocker, Diseases of the Skin, third edit., p. 967 (face, backs of the hands, and
forearms).

³ Hillairet and Vidal, quoted by Hyde and Montgomery, fifth edit., p. 590 (I have
not been able to find the originals); Malcolm Morris, Brit. Jour. Derm., 1896, p. 222
(Society trans.), exhibited a case of a woman, aged thirty, with “an unusual variety of
angioma” on both legs, symmetrically about the ankles, extending upward 4½ inches,
and down to the instep, “with a general uniform redness as a groundwork, and on this
vessels radiating from three distinct centers, with, scattered in the general redness,
small, oval, white patches (no scarring); the redness (according to the patient) first
appeared in three or four small patches on the outer side of each ankle when she was
eighteen, and gradually spread and joined.”

Colcott Fox, in reporting “A Case of Bilateral Telangiectases of the Trunk,” Brit.
Jour. Derm., 1908, p. 145, reviews the literature of telangiectatic and allied cases, with
references; and Fearnsides, “Telangiectases in Children, in Association with Wasting
and Protracted Diarrhoea” ibid., 1912, p. 35 (erythema present in all 6 cases, and
associated with telangiectases in 5; purpura was present in 2 cases, and associated
with both erythema and telangiectases; pertinent bibliography).

44

690

NEW GROWTHS

ectases, such as observed upon the face and in association with acne
rosacea, is purely operative, the best method consisting in their destruc­
tion by the electric-needle process (electrolysis), as suggested by Harda-
way, for the particulars of which the reader is referred to the treatment
of acne rosacea. Incision at several points across their length, or a
longitudinal cut with the ordinary bistoury, as likewise mentioned in
connection with the latter disease, is also practised; and when the dilata­
tions are numerous and crowded together, superficial linear scarification,
after the plan referred to in lupus vulgaris, has also been advised. I have
never had recourse to other treatment than electrolysis. It must often
be repeated, however, nor does it prevent the formation of new dilata­
tions, as long as the underlying etiologic factor, commonly unknown,
continues in force. In the so-called spider nævus, introducing the elec­
tric needle in the central dot superficially, and allowing the current (½
to 1 or 2 milliampères) to act for five to thirty seconds, often leads to its
disappearance; occasionally one or two repetitions may be necessary,
probably from too weak a current or of too short duration originally,
but it is better to err on the side of safety and thus avoid a scar, although
minute and insignificant. These spider nævi can also usually be de­
stroyed by puncturing with a plain needle, stirring it slightly around,
but not so surely as with the electric needle. The papillary varices
rarely call for treatment, the same plan, but a stronger current, usually
sufficing when measures are demanded.

For the treatment of varicose veins the reader is referred to surgical
works. As a palliative measure, to be employed when associated with
eczema, the roller bandage, to give support to the parts, can be used.
The rubber bandage may also occasionally be resorted to, but should
not be applied to the uncovered skin, as it often itself produces eczema-
tous irritation; the part should first be wrapped with a thin roller bandage,
or a long, snugly fitting stocking put on.

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