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E-IJD® - CORRESPONDENCE |
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| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 837 |
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| Resolution of multiple large spider angiomas after liver transplantation in severe alcoholic hepatitis |
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Ankur Jindal1, Aditi Gupta2, Ajeet S Bhadoria3
1 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
2 Department of Dermatology, Healthfirst Polyclinic, New Delhi, India
3 Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
Ankur Jindal
Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.IJD_761_16
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How to cite this article:
Jindal A, Gupta A, Bhadoria AS. Resolution of multiple large spider angiomas after liver transplantation in severe alcoholic hepatitis. Indian J Dermatol 2022;67:837 |
How to cite this URL:
Jindal A, Gupta A, Bhadoria AS. Resolution of multiple large spider angiomas after liver transplantation in severe alcoholic hepatitis. Indian J Dermatol [serial online] 2022 [cited 2023 Mar 31];67:837. Available from: https://www.e-ijd.org/text.asp?2022/67/6/837/370344 |
Sir,
In our institute a 55-year old man with severe alcoholic hepatitis was admitted with progressive jaundice and ascites. Physical examination showed a malnourished icteric patient with ascites, palpable liver and spleen, pedal edema and presence of multiple large spider angiomas over chest, upper trunk and back [Figure 1]. Close-up view of a large spider angioma showed presence of central arteriole with radiating thin-walled vessels [Figure 2]a. Endoscopy revealed presence of small esophageal varices. Baseline Model for End-stage Liver Disease score was 28. Three weeks later, he underwent successful living donor liver transplantation. On follow up 2 months post-transplantation, most of the spider angiomas had faded or disappeared [Figure 2]b. | Figure 1: Multiple large spider angiomas over chest, neck and upper trunk
Click here to view |
 | Figure 2: Close-up view of a large spider angioma showed (a) presence of central arteriole with radiating thin-walled vessels and (b) resolving angioma after liver transplantation
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Although spider angiomas can be seen in 10%–15% of healthy children and pregnant women, they do resolve with time or normalization of estrogen levels.[1] Typical lesions measures 1–10 mm in diameter; commonly occur in exposed areas of the skin, including the face, neck, upper trunk, and arms.[1] Presence of numerous, large angiomas in atypical locations is likely to be abnormal and may be a sign of liver disease and suggests the probability of esophageal varices.[2],[3] Possible mechanisms of their formation in cirrhosis include arteriolar vasodilatation, neovascularization from angiogenic factors such as vascular endothelial growth factor, direct effects of alcohol, and estrogen excess due to inadequate hepatic metabolism.[4]
Treatment of spider angiomas depends upon the cause of intra-arteriolar vasodilation. Besides the standard of care treatment of advanced liver disease in patients with cirrhosis, rarely fine-needle electrocautery, 585 nm pulsed, dye laser, 532 nm KTP (potassium-titanyl-phosphate) laser, or electrodesiccation have been used to clear spider angiomas for cosmetic concerns.[5],[6] The results of the procedure are generally good except for the small risk of the scar. But many a times, spider angiomas tend to recur after treatment.
Declaration of patient consent
Patient informed consent and authorization obtained prior to submission.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Khasnis A, Gokula RM. Spider nevus. J Postgrad Med 2002;48;307-9.  |
| 2. | Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, et al. Does this patient with liver disease have cirrhosis? JAMA 2012;307:832-42. |
| 3. | Berzigotti A, Gilabert R, Abraldes JG, Nicolau C, Bru C, Bosch J, et al. Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis. Am J Gastroenterol 2008;103:1159-67. |
| 4. | Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, et al. Spider angiomas in patients with liver cirrhosis: Role of alcoholism and impaired liver function. Scand J Gastroenterol 1999;34:520-3. |
| 5. | Erceg A, Greebe RJ, Bovenschen HJ, Seyger MM. A comparative study of pulsed 532-nm potassium titanyl phosphate laser and electrocoagulation in the treatment of spider nevi. Dermatol Surg 2010;36:630-5. |
| 6. | Collyer J, Boone SL, White LE, Rademaker A, West DP, Anderson K, et al. Comparison of treatment of cherry angiomata with pulsed-dye laser, potassium titanyl phosphate laser, and electrodesiccation. A randomized controlled trial. Arch Dermatol 2010;146:33-7. |
[Figure 1], [Figure 2] |
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