Dermoscopic Manoeuvre to Diagnose Spider Angiomas

Spider angiomas (SAs) are low-flow vascular malformations characterized by anomalous dilatation of end capillaries. These are usually observed in patients with high blood levels of estrogen, more commonly in alcoholic liver cirrhosis.^[1,2] The presence of SA is believed to be a representative lesion of arteriovenous connections bypassing the capillary recirculation in skin.^[1] In hepatic cirrhosis, there is an increase in blood pressure along the territories of superior vena cava circulation that could be partly responsible for the development of SA.^[1] Thus, SA could represent retrograde escape routes from the venous circulation to the arterial circulation.^[1]

Clinically, these are characterized by a central raised erythematous papule with small caliber vessels emanating from it radially like a spider’s web.^[1] Pressure on the central papule leads to paleness or complete obliteration of radiating channels with quick refilling of vessels on release of compression which is clinically diagnostic of SA.^[2] This is usually done with the help of a pin which is cumbersome and always has a risk of pin prick associated with it.

Clinical diagnosis may not always be accurate as the lesions are small. The manoeuvre of compression may not be appreciable clinically to the naked eye. Diascopy can be used to diagnose SA by similar manoeuvre but it does not give a magnified robust view like dermoscopy. Dermoscopy has been used to detect vascular lesions as it helps in easier visualization of subsurface structures like vascular lacunae.^[3] We propose the use of dermoscope to elicit the sign of compression and refilling to diagnose SA [Video 1]. This can be used in both large as well as small lesions as dermoscope allows a magnified view of the manoeuvre thus confirming the diagnosis of SA.