Cherry Angioma: Symptoms, Types, Causes and Treatment

Cherry angiomas are among the most common benign vascular skin lesions seen in adults. Although often harmless, their sudden appearance or change can raise concerns about underlying health issues or cosmetic appearance. This comprehensive guide explores cherry angiomas from their symptoms and types to underlying causes and the latest treatment options, drawing on the latest scientific research.

Symptoms of Cherry Angioma

Cherry angiomas are typically easy to recognize, yet their presentation can vary, leading to questions about their significance and when, if ever, they require medical attention. Understanding the common symptoms, and how they may manifest differently, can help in identifying these lesions and distinguishing them from other skin conditions.

Symptom	Description	Typical Location	Sources
Papule	Small red to purple bump	Trunk, arms, thighs	2 3 8
Color	Bright red, sometimes purple	Anywhere on skin	2 3
Size	Usually <5mm, can enlarge	Trunk, limbs	2 3 8
Number	Single or multiple, increases with age or exposures	Often trunk, can be scattered	1 2 7 8

Table 1: Key Symptoms

Typical Appearance

Most cherry angiomas are dome-shaped papules, bright red to purple, and measure less than 5 mm in diameter. They tend to be smooth, although some may appear slightly raised or even polypoid. The lesions often appear suddenly and may increase in number over time, especially with age or certain exposures 2 3 8.

Common Locations

Cherry angiomas commonly develop on the trunk, but can also appear on the arms, thighs, scalp, and, less frequently, the face or other areas. They are rarely found on mucosal surfaces. Some patterns, like eruptive angiomas, can involve hundreds of lesions, mostly on the trunk and proximal limbs 1 2.

Symptom Variability

• Asymptomatic: Most cherry angiomas are painless and cause no discomfort.
• Bleeding: Larger or traumatized lesions may bleed easily if scratched or injured.
• Eruptive Onset: In some cases, a rapid onset of multiple lesions (eruptive angiomas) has been noted, sometimes associated with environmental exposures or systemic factors 1 2.
• No Systemic Symptoms: In the vast majority, there are no associated systemic symptoms, though rare cases may report concurrent irritation or hypertension in the context of acute chemical exposures 1.

Types of Cherry Angioma

Although often thought of as a single entity, cherry angiomas can present in different forms and patterns. Recognizing these types assists in clinical management and helps identify cases that may merit further evaluation.

Type	Description	Distinguishing Features	Sources
Classic	Single or few, dome-shaped	Bright red, <5mm, common with age	2 3 8
Eruptive	Sudden, numerous lesions	May occur after exposures or immunosuppression	1 2 4
Petechial-like	Tiny, non-blanchable red macules	<1mm, resembles petechiae	2
Papular	Raised, spherical, or tubular	Linked to vascular loops in dermis	3

Table 2: Types of Cherry Angioma

Classic Cherry Angioma

The most familiar type, these appear as individual or scattered bright red to purple papules, typically increasing in size and number with age. They are usually asymptomatic and benign 2 3 8.

Eruptive Cherry Angioma

Characterized by the rapid appearance of numerous lesions, often after an environmental trigger (such as chemical exposure) or in the context of immunosuppression. Eruptive angiomas are more likely to raise concerns about systemic illness or viral involvement (such as human herpesvirus 8 in immunosuppressed individuals) 1 2 4.

Petechial-like Angiomas

A less common form, these present as tiny, non-blanchable red macules, usually <1 mm, resembling petechiae rather than classic papules. Such presentations may indicate a broader spectrum of capillary angiomas 2.

Papular Cherry Angioma

Histologically, these are created by dilated capillary loops in dermal papillae, resulting in a raised, dome-shaped lesion. This structure distinguishes them from flat telangiectases, which involve the superficial venous plexus 3.

Causes of Cherry Angioma

The exact cause of cherry angiomas remains elusive, but research has highlighted various genetic, environmental, chemical, and systemic factors. Understanding these can help guide prevention strategies and further research.

Factor	Evidence/Mechanism	Notes/Context	Sources
Age	Incidence increases with age	Most common in adults >30	8
Genetics	Somatic mutations (GNAQ/GNA11)	Shared with other vascular tumors	5
Chemical Exposure	2-butoxyethanol, bromides, sulfur mustard	Linked to acute or chronic exposure	1 6 7
Medications	Tamsulosin (risk), Clopidogrel (protective)	Observed in case–control study	8
Immunosuppression	Associated with viral (HHV8) sequences	Eruptive angiomas, higher viral load	4
Hormonal/Inflammatory	Prolactin, CCL2 chemokines	Altered levels post-exposure	6

Table 3: Causes of Cherry Angioma

Age and Genetics

Cherry angiomas are most prevalent in adults over 30, with incidence increasing with age. Recent genetic studies have identified somatic mutations in the genes GNAQ and GNA11 in about 50% of cherry angioma cases. These same mutations are seen in other benign and malignant vascular tumors, suggesting a shared pathway in vascular proliferation 5 8.

Environmental and Chemical Exposures

• 2-Butoxyethanol: Acute overexposure to this solvent has been associated with the eruptive appearance of cherry angiomas, sometimes persisting or increasing years after the exposure 1.
• Sulfur Mustard: Long-term skin changes, including cherry angiomas, have been observed in individuals exposed to sulfur mustard, with altered levels of prolactin and certain chemokines suggesting a role for inflammation and hormonal regulation 6.
• Bromides: Case reports indicate a possible link between chronic bromide exposure and the development of multiple cherry angiomas, although further controlled studies are needed 7.

Medications

A case–control study found that the alpha-blocker tamsulosin may increase the risk of developing cherry angiomas, while clopidogrel, an antiplatelet agent, appears to have a protective effect 8.

Viral and Immunologic Factors

In eruptive cases, especially among immunosuppressed patients, up to 53% of cherry angiomas tested positive for human herpesvirus 8 (HHV8) DNA. This suggests that HHV8 may play a role in angioma development in certain contexts, similarly to its involvement in Kaposi sarcoma 4.

Hormonal and Inflammatory Factors

Alterations in serum prolactin and the chemokine CCL2 have been found in patients with cherry angiomas, particularly following chemical exposures. These changes may contribute to abnormal angiogenesis and lesion formation 6.

Treatment of Cherry Angioma

While cherry angiomas are benign and often require no treatment, many people seek removal for cosmetic reasons or if the lesions are prone to bleeding. Multiple safe and effective treatment options are available, each with benefits and limitations.

Treatment	Method/Device	Key Considerations	Sources
Laser Therapy	PDL, KTP, Nd:YAG lasers	Effective; choice depends on skin type, size, depth	9 10 13
Electrosurgery	Electrocoagulation, desiccation	Useful for small lesions; may cause more scarring than laser	11 13
Sclerotherapy	Sodium tetradecyl sulfate	Cost-effective, minimally invasive	12
Shave Excision	Scalpel or loop electrode	Often combined with electrosurgery	11

Table 4: Treatment Options for Cherry Angioma

Laser Therapy

Laser treatment is considered the gold standard, offering excellent cosmetic results with minimal downtime. The pulsed-dye laser (PDL), potassium titanyl phosphate (KTP), and Nd:YAG lasers are all effective, though their efficacy and side effect profiles differ:

• PDL and KTP: Both are highly effective. PDL may minimize textural changes and scarring, making it preferable for visible areas. KTP may require more sessions but has a lower risk of scarring—ideal for patients with lighter skin 9 10 13.
• Nd:YAG: Fewer sessions needed, but a higher risk of scarring, making it preferable for darker skin types or deeper lesions 10.
• Post-laser changes: Transient redness, edema, and occasional hyperpigmentation can occur, but most side effects resolve within weeks 9 10.

Electrosurgery

Electrosurgery (electrocoagulation or desiccation) is an effective alternative, particularly for smaller angiomas. Larger lesions may require shave excision followed by base cauterization. This method can be associated with more textural change or scarring compared to laser, but is widely available and cost-effective 11 13.

Sclerotherapy

Sclerotherapy using agents like sodium tetradecyl sulfate is a newer, minimally invasive option. It has shown good efficacy for small cherry angiomas and may be particularly useful in resource-limited settings. Scarring risk is low, and most lesions resolve after one to four sessions 12.

Shave Excision

For larger or pedunculated angiomas, a simple shave excision followed by electrocautery of the base is a reliable method. Healing is rapid, but a small scar may form at the excision site 11.

Choosing the Right Treatment

• Cosmetic concerns: Laser is preferred for visible areas.
• Lesion size and number: Electrosurgery and sclerotherapy are practical for small or few lesions.
• Patient skin type: Nd:YAG laser may be best for darker skin to minimize pigmentation changes 10.
• Cost/accessibility: Sclerotherapy and electrosurgery offer economical alternatives to laser.

Conclusion

Cherry angiomas are benign vascular lesions that are common, especially as people age. Although their exact cause is multifactorial—spanning genetic, environmental, chemical, and immunologic influences—most angiomas pose no medical risk. Cosmetic treatment options are safe and effective, with lasers, electrosurgery, and sclerotherapy leading the way.

Key Takeaways:

• Symptoms: Cherry angiomas are small, red-to-purple papules, most often on the trunk and limbs, usually asymptomatic 2 3 8.
• Types: Variants include classic, eruptive, petechial-like, and papular forms 2 3 4.
• Causes: Influenced by age, genetics (GNAQ/GNA11 mutations), chemical exposures, certain medications, viral (HHV8) presence in some eruptive cases, and altered inflammatory markers 1 4 5 6 7 8.
• Treatment: Multiple effective options—laser therapy (PDL, KTP, Nd:YAG), electrosurgery, sclerotherapy, shave excision—should be tailored to patient needs and lesion characteristics 9 10 11 12 13.

If you notice new, rapidly spreading, or changing vascular lesions, or have concerns about your cherry angiomas, consulting a dermatologist can help ensure appropriate evaluation and management.