Telangiectasia macularis multiplex acquisita is a rarely described entity, characterized by multiple asymptomatic erythematous and/or brownish macules with telangiectasias, preferably on bilateral upper arms and trunk. We reported a 56-year-old Chinese man with telangiectasia macularis multiplex acquisita. Dermoscopic examination demonstrated an erythematous-brownish background with a striking angioid streak pattern (a central arteriole with superficial radiating small vessels attributed to spider-like eruptions) and linear-irregular branching vessels. We suggest dermoscopic features can be used to improve the accuracy of clinical diagnosis and avoid unnecessary skin biopsies.