This 46-year-old woman had slowly progressive spider angiomas, linear telangiectasias, and telangiectatic papules beginning during adolescence. Her father, who complined of recurrent nose bleeds requiring cautery, had similar cutaneous lesions. Hereditary hemorrhagic telangiectasia is characterized by the appearance of multiple punctate telangiectasias on skin and mucous membranes. Lesions usually begin to devop in adolescence and many patients present with recurrent nose bleeds. The number and size of lesions increases with increasing age. Fibrovascular anomalies if the liver and vascular malformations in the brain and lungs are common findings. Genetic studies have identified mutations at loci on chromosomes 9 and 12 which encode for endoglin and activin-like kinase 1 which are expressed on endothelial cells.
multiple widespread 2-5 mm blanching red macules and partially blanching papules