“Look at my legs” said a thirty-nine-year-old woman. We looked and in a split second knew the diagnosis. It was one of the augenblick diagnoses a dermatologist makes in 1/25 of a second when a recognizable pattern of skin disease is present. For these diagnoses, it is better to pass by a dermatologist in the hall than spend hours in a general physicians office or have a sheath of laboratory reports. Specialism has its place. A specialist does not have to re-invent the disease.

Yes, she had essential progressive telangiectasia, made up of innumerable tiny dilated blood vessels extending up her legs. We do not know the cause, but have seen them cover the entire body, becoming generalized. No, the mystery here was not the diagnosis, but why did she have it, and what could we do about it?

First, as always, there is the history. Seven years before she first noted a red patch of small dilated blood vessels over her right foot. It seemed innocent enough, perhaps due to a tight fitting shoe. But soon it appeared on the other foot, also due to a tight shoe? Then she became alarmed as this fiery red eruption began to climb up her legs. True, it was not painful, itchy, or bleeding, and there were no black and blue marks. No one else in the family had anything like it.

The dilated (telangiectatic) vessels had reached her thighs by the time she reached our office.