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A 70-year-old man is seen for “broken blood vessels” on his face. The lesions were recently noted by a relative who had not seen him in years.
The patient has a pronounced history of sun overexposure as a result of his job and his hobbies, which include fishing and hunting. As a younger man, he enjoyed waterskiing and going to the lake almost every weekend during the warmer months.
He is in decent health apart from the lesions and has no other skin complaints.
EXAMINATION
The sides of the patient’s face are covered with linear, red, dilated blood vessels running in jagged patterns. The lesions are asymptomatic and range from 0.5 to 1.0 mm in diameter; some are several centimeters long. They are readily blanchable with digital pressure, though none are palpable.
Far more blood vessels are seen on the patient’s left side than on his right. The underlying skin is quite fair and thin. In some locations (eg, the lateral forehead), there are patches of white skin free of surface adnexa (ie pores, skin lines, or hair follicles).
His dorsal arms are very rough, with hundreds of solar lentigines, while the skin on his volar arms is relatively unaffected.
What is the diagnosis?
DISCUSSION
This collection of findings is called dermatoheliosis (DHe), literally “sun-skin condition,” caused by overexposure to UV light. Telangiectasias, one manifestation, have many potential causes, but sun exposure is the most common—especially in those whose skin burns easily and frequently.
These blood vessels are simply normal surface vasculature made more obvious by two factors: First, chronic sun exposure overheats the skin for prolonged periods, leading to persistent vasodilatation that eventually becomes fixed. Second, solar atrophy may occur when the skin thins from sun overexposure, making typically invisible structures apparent.
DHe can also manifest as actinic keratosis, weathering of the skin, solar elastosis, and sun-caused skin cancers (basal and squamous cell carcinomas, melanoma, etc). The condition is incredibly common.
Many causes of telangiectasias are unrelated to sun exposure. Other processes that thin the skin—such as radiation therapy or injudicious use of topical steroids—may produce telangiectasias. Further examples include spider vessels on legs due to venous insufficiency and newly acquired vascular lesions resulting from pregnancy or liver cirrhosis. There are also two unusual but significant conditions that involve telangiectasias: a variant of systemic sclerosis called CREST syndrome (calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, and telangiectasias) and hereditary hemorrhagic telangiectasias (also known eponymically as Osler-Weber-Rendu syndrome).
Treatment for sun-caused telangiectasias includes laser and electrodessication.
TAKE-HOME LEARNING POINTS
• Telangiectasias are permanently dilated surface vasculature usually seen on the most prominently sun-exposed areas of the skin. The left face and arm are often more heavily affected than the right, since they are closer to the car window during driving.
• Telangiectasias are only one of a number of sun-caused skin changes that are collectively termed dermatoheliosis (DHe).
• Telangiectasias are important because they identify patients at risk for sun-caused skin cancers, such as basal or squamous cell carcinomas and melanoma.
• Other potential causes of telangiectasias include injudicious use of topical steroids, focal radiation therapy, pregnancy, liver disease, and rare conditions such as CREST syndrome and hereditary hemorrhagic telangiectasias.
A 70-year-old man is seen for “broken blood vessels” on his face. The lesions were recently noted by a relative who had not seen him in years.
The patient has a pronounced history of sun overexposure as a result of his job and his hobbies, which include fishing and hunting. As a younger man, he enjoyed waterskiing and going to the lake almost every weekend during the warmer months.
He is in decent health apart from the lesions and has no other skin complaints.
EXAMINATION
The sides of the patient’s face are covered with linear, red, dilated blood vessels running in jagged patterns. The lesions are asymptomatic and range from 0.5 to 1.0 mm in diameter; some are several centimeters long. They are readily blanchable with digital pressure, though none are palpable.
Far more blood vessels are seen on the patient’s left side than on his right. The underlying skin is quite fair and thin. In some locations (eg, the lateral forehead), there are patches of white skin free of surface adnexa (ie pores, skin lines, or hair follicles).
His dorsal arms are very rough, with hundreds of solar lentigines, while the skin on his volar arms is relatively unaffected.
What is the diagnosis?
DISCUSSION
This collection of findings is called dermatoheliosis (DHe), literally “sun-skin condition,” caused by overexposure to UV light. Telangiectasias, one manifestation, have many potential causes, but sun exposure is the most common—especially in those whose skin burns easily and frequently.
These blood vessels are simply normal surface vasculature made more obvious by two factors: First, chronic sun exposure overheats the skin for prolonged periods, leading to persistent vasodilatation that eventually becomes fixed. Second, solar atrophy may occur when the skin thins from sun overexposure, making typically invisible structures apparent.
DHe can also manifest as actinic keratosis, weathering of the skin, solar elastosis, and sun-caused skin cancers (basal and squamous cell carcinomas, melanoma, etc). The condition is incredibly common.
Many causes of telangiectasias are unrelated to sun exposure. Other processes that thin the skin—such as radiation therapy or injudicious use of topical steroids—may produce telangiectasias. Further examples include spider vessels on legs due to venous insufficiency and newly acquired vascular lesions resulting from pregnancy or liver cirrhosis. There are also two unusual but significant conditions that involve telangiectasias: a variant of systemic sclerosis called CREST syndrome (calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, and telangiectasias) and hereditary hemorrhagic telangiectasias (also known eponymically as Osler-Weber-Rendu syndrome).
Treatment for sun-caused telangiectasias includes laser and electrodessication.
TAKE-HOME LEARNING POINTS
• Telangiectasias are permanently dilated surface vasculature usually seen on the most prominently sun-exposed areas of the skin. The left face and arm are often more heavily affected than the right, since they are closer to the car window during driving.
• Telangiectasias are only one of a number of sun-caused skin changes that are collectively termed dermatoheliosis (DHe).
• Telangiectasias are important because they identify patients at risk for sun-caused skin cancers, such as basal or squamous cell carcinomas and melanoma.
• Other potential causes of telangiectasias include injudicious use of topical steroids, focal radiation therapy, pregnancy, liver disease, and rare conditions such as CREST syndrome and hereditary hemorrhagic telangiectasias.
A 70-year-old man is seen for “broken blood vessels” on his face. The lesions were recently noted by a relative who had not seen him in years.
The patient has a pronounced history of sun overexposure as a result of his job and his hobbies, which include fishing and hunting. As a younger man, he enjoyed waterskiing and going to the lake almost every weekend during the warmer months.
He is in decent health apart from the lesions and has no other skin complaints.
EXAMINATION
The sides of the patient’s face are covered with linear, red, dilated blood vessels running in jagged patterns. The lesions are asymptomatic and range from 0.5 to 1.0 mm in diameter; some are several centimeters long. They are readily blanchable with digital pressure, though none are palpable.
Far more blood vessels are seen on the patient’s left side than on his right. The underlying skin is quite fair and thin. In some locations (eg, the lateral forehead), there are patches of white skin free of surface adnexa (ie pores, skin lines, or hair follicles).
His dorsal arms are very rough, with hundreds of solar lentigines, while the skin on his volar arms is relatively unaffected.
What is the diagnosis?
DISCUSSION
This collection of findings is called dermatoheliosis (DHe), literally “sun-skin condition,” caused by overexposure to UV light. Telangiectasias, one manifestation, have many potential causes, but sun exposure is the most common—especially in those whose skin burns easily and frequently.
These blood vessels are simply normal surface vasculature made more obvious by two factors: First, chronic sun exposure overheats the skin for prolonged periods, leading to persistent vasodilatation that eventually becomes fixed. Second, solar atrophy may occur when the skin thins from sun overexposure, making typically invisible structures apparent.
DHe can also manifest as actinic keratosis, weathering of the skin, solar elastosis, and sun-caused skin cancers (basal and squamous cell carcinomas, melanoma, etc). The condition is incredibly common.
Many causes of telangiectasias are unrelated to sun exposure. Other processes that thin the skin—such as radiation therapy or injudicious use of topical steroids—may produce telangiectasias. Further examples include spider vessels on legs due to venous insufficiency and newly acquired vascular lesions resulting from pregnancy or liver cirrhosis. There are also two unusual but significant conditions that involve telangiectasias: a variant of systemic sclerosis called CREST syndrome (calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, and telangiectasias) and hereditary hemorrhagic telangiectasias (also known eponymically as Osler-Weber-Rendu syndrome).
Treatment for sun-caused telangiectasias includes laser and electrodessication.
TAKE-HOME LEARNING POINTS
• Telangiectasias are permanently dilated surface vasculature usually seen on the most prominently sun-exposed areas of the skin. The left face and arm are often more heavily affected than the right, since they are closer to the car window during driving.
• Telangiectasias are only one of a number of sun-caused skin changes that are collectively termed dermatoheliosis (DHe).
• Telangiectasias are important because they identify patients at risk for sun-caused skin cancers, such as basal or squamous cell carcinomas and melanoma.
• Other potential causes of telangiectasias include injudicious use of topical steroids, focal radiation therapy, pregnancy, liver disease, and rare conditions such as CREST syndrome and hereditary hemorrhagic telangiectasias.
