Idiopathic telangiectasias are fine, dilated intracutaneous veins that are not clinically significant but may be extensive and unsightly.
Telangiectasias are usually asymptomatic. However, some patients report a burning sensation or pain, and many people consider even the smallest telangiectasias cosmetically unacceptable.
Telangiectasias can usually be eliminated by sclerotherapy, intracapillary injections of 0.3% solution of sodium tetradecyl sulfate through a fine-bore needle. Hypertonic saline 23.4% is sometimes used but causes fairly severe, temporary, localized pain; therefore, large areas of spider veins (multiple telangiectasias) may require several treatments. Pigmentation may develop but usually subsides, often completely. Skin ulceration may result if the injection is extravascular or too large.
Laser treatment is effective, but large areas require several treatments. Small telangiectasias may persist or recur after initial treatment.