What are these Red Dots on my Skin?

Angiomas

Doctor, what are these pesky red dots on my skin? I get asked this question at least 10 ten times a day every workday.  My response is always, “little red dots that people start getting on their skin with time, usually starting in the 30s.”  I phrase it this way because it sounds better and kinder than saying they come with aging, but they do.  Occasionally we see them in younger patients or increased numbers during pregnancy, but mainly they come with aging.  Sorry. 

Cherry Angiomas are the most common type of angiomas often occurring by the hundreds and thousands on patients 30 and up.  They look like someone took a red felt tip pin and dotted them on.  Usually, they aren’t raised or problematic for any reason, just a cosmetic concern.  Occasionally, patients will nick them shaving, but that’s about it.  

Spider Angiomas aka spider nevi or spider telangiectasias, occur at all ages.  I have seen them as early as age two on my daughter.  They have a center feeder blood vessel and “legs” that radiate from the center feeder.  They are usually on the upper cheeks, but they can be on the hands, feet, anywhere.  When a patient is flushed from overheating, the shower or exercise the “legs” engorge and cause a dime or nickel size redness of the skin that fades back to the original in a few hours.

Venous Lakes are blue-purple bumps almost exclusively seen on the lips of older adults 60 and up.  Because they can be quite large, the size of a pea, and deep.  Some of these are better treated with a vascular laser.

Because angiomas are mostly a cosmetic concern, insurance usually won’t pay to remove them.  They can be removed with cautery, aka electrodessication, or with a vascular laser.  Although we have a vascular laser, it is often simpler, cheaper, and more reproducible to electrodessicate them, especially the masses of cherry angiomas.  We charge per lesion at the time of treatment if a patient wants some removed for cosmetic reasons.  This is something we do EVERY DAY.  Occasionally they are stubborn, but most respond well and leave no visible scar.  Unfortunately, most patients will continue to get more over time, so it is an ongoing cost and job to remove all of these.

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