By Gary M. White, MD
Telangiectasias commonly occur on the face of middle-aged and older adults. They may occur in association with rosacea, but they may not. Indeed, a patient with facial telangiectasias without pimples or pustules does not have rosacea. Several drugs--particularly calcium-channel blockers--have been described as causing photodistributed-telangiectasias (e.g. felodipine, nifedipine, amlodipine, and diltiazem) [JAAD 2001;45;323]. Other risk factors that have been implicated include excessive sun exposure, aging, hormonal variations, smoking, alcohol ingestion, filler implants, topical and systemic corticosteroids and collagen vascular disease.
Small, thread-like blood vessels are visible just below the skin's surface. The nose and cheeks are the most commonly affected areas. The patient is usually fair-skinned. Sometimes an atrophic actinic keratosis can have telangiectasias. A telangiectatic macule is sometimes called a telangiectatic mat.
A drug history should be taken. If the patient is on a calcium channel blocker such as those noted above, it may be prudent to switch to a different class of medication for 2 months to see if a reduction in the number of telangiectasias is seen. It must be emphasized that neither the tetracyclines nor topical metronidazole remove facial telangiectasias.
The pulsed-dye laser is the most commonly used and usually is effective without scarring. Rarely however, textural changes of the skin may follow laser therapy [AD 1999;135;472].
In a study looking at recurrence of telangiectasias after laser treatment [JEADV 2017;31;1355], the following were found to be associated with recurrence: hypertension in men, tanning, filler implants and aesthetic surgery. In women, hormonal treatment for menopause was protective.
Light electrocautery with a fine epilating needle is quite effective though it may be painful for the patient and tedious if the lesions are numerous. Alternatively, a 30 gauge needle may be employed as follows: Treatment of Nasal telangiectasias and a 30 gauge needle with bipolar cautery [JAAD 2016;74;e49–e50]. EMLA is applied 30 minutes before for pain control. Then a 30 gauge needle is used to puncture the skin at the site of the telangiectasia. Then a bipolar electrocautery unit is applied to the needle and activated for 1 second at 3 (30 Watts). The vessel disappears immediately. Several sessions may be required.
Telangiectasias may present as a vascular macule, called a telangiectatic mat.
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