By Gary M. White, MD

Telangiectasias of the face

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.

Electrocautery and Needle-Assisted Electrocautery

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.

Additional Pictures

Telangiectasias may present as a vascular macule, called a telangiectatic mat.
Telangiectatic mat of the face


Homepage | FAQs | Use of Images | Contact Dr. White

It is not the intention of RegionalDerm.com to provide specific medical advice, diagnosis or treatment. RegionalDerm.com only intends to provide users with information regarding various medical conditions for educational purposes and will not provide specific medical advice. Information on RegionalDerm.com is not intended as a substitute for seeking medical treatment and you should always seek the advice of a qualified healthcare provider for diagnosis and for answers to your individual questions. Information contained on RegionalDerm.com should never cause you to disregard professional medical advice or delay seeking treatment. If you live in the United States and believe you are having a medical emergency call 911 immediately.

e in the United States and believe you are having a medical emergency call 911 immediately.